What is Value in Value-Based Care

02/14/2022 Compiled by Valmeek Kudesia

What is The Value of Data?

There are many situations where data is absolutely required for diagnosis and treatment. Advances in medical sciences and life sciences continue to increase the (appropriate) uses of data in healthcare. To counter inappropriate uses of data, Medical training emphasizes "Why collect this data?" and "Will this result change your medical management?" Truly, the value of an answer from data must be defined by the value of the question. In clinic, I remember ticking boxes on the laboratory order sheets and later electronic health record (EHR) laboratory order sets. I also remember confused phone calls with a lab technician as we both tried to figure out what color tubes are needed for which lab tests. Just be safe, we always got a gold top, red top, and a purple top (if anything to do with cell counts). Frankly if we were drawing a gold top and red top, then we might as well order the comprehensive metabolic profile (CMP) and whatever else make sense i.e. not necessarily inappropriate. The upshot of many clinic visits was that despite good intentions and ordering nothing inappropriate...I still felt like I didn't get the "correct" or "revealing" answers that helped me put together "the way forward" (neither for the person who was the patient nor for myself)

Question.Value ⟶ Data.Value

Leaving aside syntax shenanigans, I can always order and collect more data as a clinician. To my knowledge, there's no concept or quality measure to indicate "Careful! Too much data" in the same way for "Careful! Too many medications" i.e. polypharmacy. I had the honor to be of service during the onset of the COVID-19 pandemic and to demonstrate the value of data as a therapeutic ally as we rushed to provide care and support to those who needed it most. An estimated 2,314 exabytes of global healthcare data was newly created in just 2020 of course not all from laboratory. As I journeyed through the provider, payer, care management/coordination sides of the US Healthcare system and their respective data jungles (some of which are beginning to intertwine) I encountered ever varying data. However, a subset of questions seemed to repeat (either literally or as close variants) within the same side (e.g. provider) and across sides (e.g. payer and provider); these questions defined the value of the varied answers provided by data.

What is the "Value" in Value-Based-Care?

As the US Healthcare moves (or attempts) toward value-based care (VBC), I think we have to answer the following question:

Here I share a distilled list of value-defining questions (as best I understand) across an individual and a population, gathered up from across provider, payer, care management/coordination verticals. This represents my best understanding of how one might approach the underlying value in VBC...or just plain good care.

Foremost, I hope that my experience is valuable for others' thoughts and work. Of note, I find interesting the analogous pattern across an individual and a population; any population *is* a collection of individuals. As far as I know, I've never prescribed penicillin or ordered a troponin lab test for a "population"; I have done both for many individuals.