Value

As the new year starts, many of my patients are scrambling to present their new insurance cards and understand any changes in their plans. It’s a given that premiums have gone up and the days of $10 co-pays are long gone. Many people are wondering if all that money is really buying what was intended. Michael Porter of the Harvard Business School presents an interesting perspective in the New England Journal of Medicine (N Engl J Med 363:26).

Professor Porter believes, “the failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians’ practices.”

How are we to measure quality? Here is one of the HEDIS 2010 measures: was the body mass index (BMI) recorded in the chart? That’s it. In other words, the physician who was foolish enough to waste time discussing nutrition, exercise or health maintenance will receive the same grade as the physician who recorded a weight but made no comment or recommendation. The second physician may even get extra points for efficiency.

I agree with Professor Porter – we need to achieve high value for patients. We need better ways to measure quality and results. We cannot lump all patients together: different populations need different bundles of services. We need to make sure that our health care dollars are spent wisely.