Value in Health Care: In the Eye of the Beholder

Value is defined differently depending on who is defining it. Still, whether value is being defined by the health care provider, the payer, the patient, or industry, the importance of evidence-based treatment decisions and care practices is acknowledged by all stakeholders.

Value to payers is often defined in terms of lower health care costs and improved patient outcomes, translated into lower resource utilization. Chronic obstructive pulmonary disease (COPD) has a high prevalence among older adults and is the third leading cause of mortality in the United States. COPD exacerbations can require hospitalizations, resulting in high morbidity and economic burden. In a retrospective cohort study, Flavia Ejzykowicz, PhD, and colleagues compare inpatient resource use and direct health care costs among patients with COPD treated with short-acting beta agonists (SABAs) or long-acting beta agonists (LABAs). The results demonstrate the impact of treatment decisions on value for payers (page 31).


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In some cases, such as with the implementation of a clinical pathway, improved value to all stakeholders can be achieved simultaneuously: value to the payer, in the form of cost savings; valye to the provider, in the form of decision support; and value to the patient, in the form of improved clinical outcomes. Aymen Elfiky, MD, MPH, MSc, and Marina Kaymakcalan, PharmD, describe a clinical pathways initiative to address the growing variations in care practices with the advent of new treatment approvals for advanced prostate cancer. A multidisciplinary group of providers, pharmacists, and quality improvement specialists developed and implemented a core set of decision support rules for the use of granulocyte colony stimulating factor (GCSF), a common growth factor support medication, as primary prophylaxis for prevention of treatment complications in advanced prostate cancer patients receiving palliative chemotherapy (page 39). As a result of improved treatment decision processes, all stakeholders were able to benefit.

Elsewhere in this issue, value is further defined by the pharmaceutical industry, as the question of how price influences a product’s perceived value is explored (page 25), and by patients themselves, as the benefits of patient navigation outside the context of cancer care, and specifically within Alzheimer’s disease (AD) clinical pathways, are outlined (page 27).

The articles in this issue highlight different definitions of value, but they also demonstrate how often these definitions overlap. Improving the processes used to determine care for patients, such as through clinical pathways, has beneficial outcomes for all stakeholders involved.