“Don’t pay for that,” my wife exhorts me as I consider ordering a bottle of premium wine during dinner. “You can buy that same wine for 10 times less at Costco. It’s not worth it.” I reconsider. Indeed, it will not be worth it if we are not enjoying it because of the cost. It does not have good value.
Most business leaders think constantly about value and seek to never pay more for something than they need to, especially if it will not contribute to the company’s goals. But when it comes to healthcare, they are paying for exactly what they want to avoid. Healthcare costs too much and doesn’t deliver on what it promises. Healthcare no longer provides us with what we value from it.
We knew all this before the pandemic, but COVID-19 has laid bare the fragile and vacuous nature of even the value we thought we had. Life expectancy in the U.S. has declined since 2014 and this decline dramatically accelerated during the COVID-19 pandemic. Among a group of industrial countries (including the U.K., Canada, Germany, Japan, France and others), mortality rates in the U.S. are higher at all ages from birth to approximately age 80.
Mental illness and suicide, especially among our youth, have skyrocketed, and rates of chronic disease have accelerated. The opioid epidemic, which was so much on everyone’s lips before the pandemic, is three times worse now with over 100,000 deaths per year. Health disparities have dramatically widened, and access to good care has declined. Costs have continued to rise rapidly.
The healthcare system has been powerless to address these issues. Instead of responding, it has gotten weaker and less able to do its job. Hospitals are in financial crisis with more than half losing money in 2022. Providers are experiencing high rates of burnout with physician rates at an all-time high of 63%. Twenty percent of healthcare workers left since the pandemic began. Health technology is laying off workers.
Values
Pre-pandemic, the movement from volume to value-based care was the focus of healthcare improvement. After witnessing the performance of our health system during a global pandemic we need more than improvement; we need transformation. This transformation requires that we ask three fundamental questions: “What is value?” “What do we value?” and “How do we move toward values-based care?”
We propose aligning values for our health system within the framework of the “Quintuple Aim” or the “Five Aims for our Health System.” These are: actual health, a good experience, well teams, reasonable costs and access for all.
For decades, these goals have been the main products sought by payers and promised by healthcare leaders. They are the values we seek and pay for from healthcare services.
The 'Four Es'
To achieve value, these five aims can be put into the 4 Es of effectiveness, efficiency, experience and equity:
1. Effectiveness
How do we move our health system toward prevention and risk mitigation? Preventing and detecting disease earlier before it requires treatment provides top dollar. COVID-19 vaccinations and tests are the perfect example of how we need to invest in preventing and detecting disease by preventing its spread and hospitalizations.
If we had prevented more lifestyle-related diseases to begin with, such as obesity, diabetes, high blood pressure and heart disease, COVID-19 mortality would have been much less, perhaps even preventing global shutdown.
2. Efficiency
We invest significantly less in primary care than most other countries, even though we know that quality primary care lowers costs and improves health. Investment in primary care and our public health infrastructure would improve all of the Quintuple Aims and would have prevented tens of thousands of deaths during the pandemic.
3. Experience (Patient + Provider)
We need to urgently address physician/clinician burnout in the context of the Great Resignation and Quiet Quitting. Quitting healthcare means no services. Caregivers need more time, fuller teams, and better technology that can predict, personalize, and prevent bad health outcomes. We know how to measure, predict, and prevent risk in healthcare. We need to do it.
4. Equity
Most companies are addressing diversity, equity, and inclusion. The need to assure our healthcare workforce represents the people it serves. Transparency in the workforce and effective, representative leadership is the path to this inclusion. We have talked about and measured health disparities for decades.
We need to advance TechQuity and move to actions that reduce and eliminate them in geography, race/ethnicity, language and SOGI for the poor and for people with disabilities.
The values formula
From the above, we can derive the formula for healthcare services of value and a product that meets our values. It is:
VALUES = EFFECTIVE health outcomes + EFFICIENT systems with strong primary care and public health + Positive patient and provider EXPERIENCE + Diversity, EQUITY and inclusion.
We recommend all stakeholders from patients to providers to payers to governments to assure our health system delivers on these values.
Kyu Rhee, M.D., is the former chief medical officer at CVS Health. Wayne Jonas, M.D., is the president of the Healing Works Foundation.