The Bigger Picture: what you didn’t learn in medschool! Value-based healthcare delivery.

Victoria Brennan, MD
Fellow in Radiation Oncology at DFCI/Brigham and Women's Hospital
PGY-6

01/31/2020

Value-Based Healthcare Delivery Course

Approaching this course as an outsider, with my core training in a socialized healthcare system, I was keen to explore a different system, learn the practical side of United States healthcare and try and decipher a system where value is predetermined by insurance companies.  Instead of learning about the differences of our healthcare systems, instead it highlighted mutual ground we share, where change is urgently required.

Defining the value of healthcare was a key concept that I had not previously considered prior to this course. In training, we are consumed with providing state of the art care, with competing interests of pharmaceutical industries and advanced state of the art technologies dominating decision making. Inflating costs diminish the added value novel therapies provide and continue to add layers of complexity to a buckling framework that is the current clinical infrastructure. Costs are always a consideration, whether it be in a cash-strapped government funded public system, or a private system dealing with external competition and financial losses from uninsured patients and determining true value can only be reached by considering the patient’s perspective. By recentering our focus, not on the large and long established department divisions with their associated traditional hierarchies, and instead look from the ground up at the individual patient’s treatment pathway, it is easy to identify our inefficient and outdated status quo.

The many case studies dissected at this course that outline innovative approaches to IPUs and their success across a wide range of illnesses and clinical settings is inspiring. Outcome measurement is too often overlooked but is one the key determinants that drive change and improvement. The fact that the tools that most leaders in these case series had was simply an idea, motivation and a background of attending the HBS VBHD course is truly inspiring. Going forward, these are ideas that I will continue to consider and try to apply to my own field. Physicians too often shy away from leadership in healthcare. This course illustrates the necessary input required from those with an in-depth knowledge of the clinical pathway and its inadequacies to address areas where change is most needed.