Recent research* in the US surveyed over 2,000 doctors about how much medical care they thought was unnecessary in their medical speciality. The response from doctors showed that 20.6 per cent of overall medical care was unnecessary. Considering the various medical complications that can come from any form of treatment, these are alarming figures.
The imperative to improve quality and decrease cost in medical care is prompting stakeholders to focus on shared value-based care through a patient-centric approach
Current medical approaches are deeply flawed as there is a constant conflict between healthcare providers, payers and patients. With medical costs sky-rocketing and patient satisfaction at an all-time low**, a different approach is clearly required. The imperative to improve quality and decrease cost in medical care is prompting stakeholders to focus on shared value-based care through a patient-centric approach.
This is part of a wider shared value movement that began from an article in the Harvard Business Review***; one that looks at the crucial connection between the economic competitiveness of businesses, communities and the eco-systems they operate in. Rather than being another form of corporate responsibility, the focus is on creating value. This value is then ‘shared’, creating a mutually beneficial arrangement for everyone in the system that meets both societal needs and those of businesses to remain profitable. This philosophy has become a driving force for businesses across a number of industries.
What does shared value in healthcare look like?
The shared value approach is the value found at the intersection between the healthcare provider, the payer and the patient. This intersection is where doctors reduce unnecessary overuse and misuse of medicine, and provide medical care according to evidence-based and international standards. It is also where insurance companies keep their members' fees in check by not being required to reimburse medical institutions for unnecessary and invalid tests and procedures, and where the patients are guaranteed quality care and optimal outcomes. This intersection is also known as personal medical case management (PMCM).
Current medical approaches are deeply flawed as there is a constant conflict between healthcare providers, payers and patients.
PMCM providers assign a case management team comprised of a nurse and a specialist doctor. The case management doctor reviews the case and consults with a global network of specialists to get multiple opinions. The doctor is able ensure accessibility and implementation of quality medical care and reduce unnecessary overuse and misuse of medicine.
Once multidisciplinary consultations have been made, the case management doctor will explain the diagnosis in detail to the patient. The case management doctor will then recommend the most optimal treatment option and the leading treating specialist for that particular disease.
Building the future
The evolution of healthcare services towards a shared value approach ensures the correct diagnosis and treatment while preventing unnecessary consultations, medications, treatments, procedures or surgeries, avoiding misuse and overuse while optimising healthcare outcomes. The shared value approach lays the foundations to simultaneously provide patients with better medical outcomes and improved medical cost management for their insurers, thereby keeping insurance premiums sustainable. Only by sharing the value with payers, providers and patients is a future with affordable and accessible quality healthcare possible. ■