Value-Based Care: Crucial Conversations and State of Mind


​Value-Based Care: Crucial Conversations and State of Mind

Matthew Stiefel and Kevin Nolan (2013) wrote, “The three parts of the Triple Aim [1. Improving the patient experience of care, 2. Improving the health of populations, and 3. Reducing the per capita cost of health care], taken together, provide a useful framework for measurement of value in health care. Value can be conceptualized as the optimization of the Triple Aim, recognizing that different stakeholders may weigh the three parts differently. The combination of care experience and cost enables measurement of efficiency. Similarly, the combination of population health outcomes and care experience enables measurement of effectiveness of care, or comparative effectiveness when comparing alternative treatments. Combining all 3 parts of the Triple Aim enables measurement of cost-effectiveness, or overall value.”

Hopefully, the previous paragraph resonates with AACVPR members following the Annual Meeting, what with the numerous R2R-related presentations that were focused on the crucial conversations and state of mind of our health-care system delivering value-based care (VBC). Clinicians have the responsibility to ensure the right patients reach the right care services, and their outcomes can be measured as a value of the health-care delivery process. In light of this messaging, the HCRC committee has formed a VBC workgroup with Tracy Herrewig and Amy Knight as co-chairs. The mission of the VBC Workgroup is to support the Roadmap to Reform Initiative by evaluating and executing deliverables that educate and create awareness centered on value-based care.

To create more rapid improvement, many medical centers are engaging in learning collaboratively to catalyze shared innovations. As an example, The High Value Healthcare Collaborative (HVHC), a consortium of 13 health-care delivery systems and the Dartmouth Institute for Health Policy & Clinical Practice, has created a data trust that includes a number of “marts” customized for specific conditions. The mission of the HVHC is to improve health care value—defined as quality and outcomes over costs, across time—for its service population, in a sustainable manner, while serving as a model for national health-care reform. The Teaching Value in Healthcare Learning Network, which is sponsored by the nonprofit Costs of Care and the American Board of Internal Medicine Foundation, is a community of health system managers and educators who share educational resources and strategies related to teaching health care value. The member benefits include:

  • Influence on national agenda of healthcare and payment reform through data-driven findings
  • Earlier knowledge on best practices, rather than waiting for peer-reviewed publications
  • Access to shared materials, tools, and templates that would otherwise be created or purchased independently
  • Inter- and intra-system comparative analytics combining member data
  • Academic opportunities through authorship and mentorship
  • Peer-to-peer relationships and sharing knowledge and lessons learned (avoid “reinventing the wheel”)


I highlight this HVHC as a very successful blueprint or prototype for discovery and dissemination of VBC models of care. The AACVPR VBC workgroup will attempt to initially outreach and engage Affiliate leaders and members to possibly design and map a similar prototype of a high value health-care network among the affiliate memberships and other members at large to reach the level of some of benefits that HVHC has been able to provide to its members. This blueprint will not be achieved in the immediate future, but let’s start to have the crucial conversations and embrace a state of mind to design, implement, and evaluate VBC to all our cardiopulmonary patients

Stiefel M, Nolan K. (2013). Measuring the triple aim: A call for action. Population Health Management. 16(4): pp. 219-220.