The Value of the Value Based Health Care Seminar

Jaskaran Singh, MD
Fellow in Critical Care Anesthesia at Massachusetts General Hospital
PGY-5

HBS Campus; Morning of the first day of the
VBHD Seminar 

As a fellow in critical care medicine at Massachusetts General Hospital, I was afforded the opportunity to attend the Value Based Health Care Seminar at Harvard Business School from January 15-17, 2020. In our evolving healthcare landscape, understanding the principles of efficiency and value based care have become increasingly important. The course, led by Dr. Michael Porter, went through numerous case studies of organizations that were successfully built around the principles of value based care: some on a large scale (Cleveland Clinic, Children’s Hospital of Philadelphia) and others on a more focused aspect of health care (Martini Klinik with prostate cancer and Oak Street Health with primary care).  Discussion was fostered in the classroom, with participants from a range of specialties at Partners, incorporating their unique backgrounds to discuss the merits and shortcomings of each case. It is important for trainees to have this experience to ensure that new reforms in our health system do not compromise the safe, high-quality, patient-centered ideals on which the profession of medicine was founded.

Traditionally, end-of-life has been one of the most expensive components of American health care spending – with some estimates indicating up to twenty percent of health care dollars are spent in the intensive care unit. It would be important in a future intensivist role to establish a working group to carefully determine the costs of critical care admission based on the time-driven activity-based costing principles taught in the course instead of traditional ratio of costs to charges models before enacting projects that serve to contain this growing area of health care expenditure. The Value based Health Care Seminar also shifted my thinking to focus more on outcomes that matter to our patients (quality of life, functional status) and less on traditional metrics that may be easier to measure (mortality rate, estimated blood loss) but not necessarily true indicators of quality care. From an administrative perspective, the course helped to develop a framework to organize a practice centered around collaboration of multiple specialties involved in the care of a singular patient problem. The CVICU of the Heart Center at MGH is one example I see that puts this organizational strategy into practice. Lastly, from a payments perspective, the course extolled the benefits of bundled payments, when initiated with careful planning, as a model to reduce costs and improve outcomes in lieu of our traditional fee-for-service model.

Traditionally, it has been taught that when it comes to health care one cannot improve cost, quality, or access without compromising one of the others. The central principles of this course were concrete and applicable to future projects I will undertake both as an intensivist and administrator that would ideally keep all three pillars in focus as we work towards a more sustainable future health care delivery model.