Value-Based Medical Delivery Not Based On Cost Alone

Armen Hareyan's picture

Dr. Louis W. Sullivan, MD joined a host of provider and patient advocacy organizations in the nation's capital to voice their opposition to health care that emphasizes cutting costs rather than improving patient outcomes.

Decrying what they called "cost-over- care" health delivery, Sullivan and partners highlighted the adverse consequences of sacrificing quality of care for the sake of budgets, asserting the movement would constitute an "impending health care crisis" if not addressed. Instead, they offered their own comprehensive approach to affordable health care for America.

"In the U.S. health care system today, there is a growing trend by public and commercial payers to shift the rationale for medical treatment decisions away from patient outcomes toward immediate treatment costs," said Sullivan, who is President Emeritus of the Morehouse School of Medicine in Atlanta, Ga. "Having spent nearly 50 years in the medical profession as a researcher, instructor and health policy advocate, I am greatly troubled about our health system if it continues to be unbalanced in such a way."

The event presented several examples of "cost-over-care" health delivery, including the so-called evidence based medicine (EBM) movement that is in wide use today. EBM was originally designed to utilize multiple sources of medical evaluation to determine the overall effectiveness of medicines and services. But the term has been hijacked by a number of US health care payers and governments as an excuse to justify measures designed solely to cut immediate costs. Other examples of cost-over-care health delivery cited were the Consumer Reports "Best Buy" Drugs, medical disparities and broad applications of therapeutic substitution.

"Sadly it is true that when it comes to health care, far too many policymakers and elected officials know the cost of everything and the value of nothing," said Michelle Plasari, President, RetireSafe. "RetireSafe, an organization representing almost 400,000 American consumers, is proud to support Dr. Sullivan's initiative. Health care delivery is often encumbered by the very process which ought to be focused upon making it simpler, easier and more accessible. It is time to focus upon the quality care aspect of health care and we thank Dr. Sullivan for leading the way."

As an alternative to immediate cost-based policies, Sullivan laid out his idea for how the U.S. can avoid a health care crisis through a "symphony of health care delivery." Within this paradigm, the doctor represents the conductor and each element of quality health care represents a different section of the symphony. Too much emphasis on one particular "instrument," or service area, such as cost alone, drowns out other important elements. Deviating from this "symphony" approach, Sullivan said, leads to discordant, "off key" health care results for patients.


"In today's symphony of health care delivery, the emphasis on 'cost over care' is like a badly timed clash of cymbals or an overly-loud base drum," Sullivan said. "For sure, cost is a critical element, or 'section' in this delivery of care; but overemphasized, it overwhelms the other elements of our health care delivery. Today, I am calling for value-based health delivery, not immediate cost-based medicine."

Sullivan plans to visit with groups across the nation who are looking at numerous immediate cost-over-care situations, instances of medical disparities and flawed "patient outcome" programs that systematically over-emphasize immediate cost in their health care delivery. The objective of the campaign is to facilitate a national dialogue on the need for a balanced, symphonic approach to the question of health delivery to ensure that:

-- Care is focused on maximizing outcomes and value for INDIVIDUAL patients

-- Care is organized around medical conditions and episodes of care, not on specific services

-- Quality of care is measured by improvements in patients' health and outcomes

-- Systems of care acknowledge the rapidly-evolving nature of clinical evidence and encourage the development of innovative approaches to treatment.

-- The best way to address health costs is by improving health outcomes and thus value to the patient.


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