The medical profession must refocus attention on the patient to deliver quality care at greater value, according to speakers at the Christiana Care Value Institute’s inaugural symposium “Value: Medicine’s New Frontier” held Monday, April 30.
More than 200 health care experts from top institutions in the nation discussed how returning to the basics of medicine – listening to the patient, better use of resources and a greater emphasis on quality and safety – can transform patient care and deliver far greater value.
Christiana Care established the Value Institute this year to study and design solutions to the questions of value in the real world settings of health care delivery, said Timothy J. Gardner, M.D., Medical Director of Christiana Care’s Center for Heart & Vascular Health and interim Director of the Christiana Care Value Institute. He said the institute aims to implement strategies to achieve better health outcomes at lower costs.
The speaker lineup included widely respected thought leaders in the health care industry: Robert Laskowski, M.D., MBA, president and CEO of Christiana Care; Virginia L. Hood, M.D., immediate past president, American College of Physicians; David B. Nash, M.D., MBA, dean of the Jefferson School of Population Health; Michael Lauer, M.D., director of the Division of Cardiovascular Sciences at the National Heart, Lung and Blood Institute, National Institutes of Health; and Peter L. Slavin, M.D., president of Massachusetts General Hospital. U.S. Senator Chris Coons and Arkadi Kuhlmann, MBA, founder of ING DIRECT USA, also participated.
“Value is more than the benefits and costs of serving our patients’ needs,” said Dr. Laskowski in his address “Value: the Patient’s Perspective.” “The concept of value is grounded in the needs of our neighbors as they perceive them,” he said. Dr. Laskowski outlined his views in an op-ed published prior to the symposium.
He said those who deliver and finance health care must continually remind themselves that it is “first and foremost” the patient who is served.
“On the issue of patient care, what the individual “feels” appears to matter at least as much as the facts,” he said. “We who lead health care must understand these feelings as well as the facts if we are to improve quality and safety and reduce costs.”
What is at issue, said Dr. Hood, is “conserving resources at the physician-patient level.” She said the drivers of cost in health care are technology, chronic disease and aging, excessive pricing, fewer primary care services and liability.
She cited a recent American College of Physicians survey that found 42 percent of primary care physicians believe patients are receiving too much testing.
She said the national debate should be about “Rational care, not rationing care. We need to encourage people to follow treatment guidelines if they are relevant to the patient.” To achieve high-value, cost conscious care, she supports more patient-centered medical homes.
Dr. Nash, who is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy of Thomas Jefferson University in Philadelphia, PA, spoke about quality and safety in health care.
“In order to make health care reform work, we need medical education reform,” said Dr. Nash. This is a cultural challenge. Doctors are well prepared in science-based medicine and in obtaining the skills necessary to care for patients. But very few are qualified to measure and improve what they do every day.”
On average, the typical medical student gets one day in four years of true didactic training from an expert in quality and safety, he said. There is a great need for a new cadre of leaders with content experience in the quality and safety field.
“I’m an optimist,” he said. “Given the leadership we have in a room like this, we can get the job done.”
There’s a lot the medical profession can learn from other professions, including banking, said Arkadi Kuhlmann. “To tap into the value proposition, health care must address the emotional side of the equation.” Banks do this well, he said.
“Consumers are driven by an emotional assessment. This requires innovation and flexibility,” he said. “You need to adjust business model so the customer understands the value proposition because happy customers end up talking about what they’re happy about.”
Dr. Lauer believes health care must return to its scientific roots. “Every clinical encounter between doctor and patient is an opportunity to leverage the power of the scientific method – the most powerful tool at our disposal for assuring that medicine will continue to evolve as one of human society’s greatest accomplishments,” he said.
“We need to rediscover the value of real world clinical trials,” he said. Unfortunately, the majority of doctors have nothing to do with clinical trials.”
“I believe one of the biggest health care problems is the cost of health care itself,” said Dr. Slavin. “We have to see if we can bend the cost curve and make health care more affordable. We have no other choice. We don’t want to finance unnecessary care; we want to finance care that adds value to our patients because that in the end is most sustainable.”
He advocates shifting to population management as a way to ensure high-quality health care while controlling costs.
“We need to re-learn what we have forgotten,” said Sen. Coons. “It’s about learning what we used to know, the things we knew before we became so well educated.”
He cited a recent grant Christiana Care received to care for elderly patients in the home. “It’s a perfect example of returning to the basics of care.”