How Do You Approach Value to Provide High Quality, Affordable Care?

Q: With value playing such a big role in healthcare today, what overall efforts are underway at the Digestive Disease & Surgery Institute to ensure the best care is provided to patients?

A: Provision of value is today’s key concept in healthcare. Value includes improving the quality or outcome of care while maintaining or reducing cost.

This is crucial because 50 percent of hospitals in the United States are currently losing money on clinical operations. Improving the value ratio is critically important for the Cleveland Clinic and other hospitals to sustain our healthcare system.

With changes in insurance, patients are also increasingly hit with out-of-pocket deductible expenses. It is our duty as providers to reduce the cost of care to keep our healthcare system viable and to improve affordability for each individual patient.

But how? To do this, we must approach the value equation from several different perspectives. First and always, we must focus on maintaining or improving the quality of care that we provide our patients. Interestingly, there is abundant evidence that as we improve and standardize care pathways, we do improve the quality of care ― and we almost always reduce the cost.

Particular areas we focus on:

• Standardizing the use of medications for outpatients– This effort can particularly help affordability and value for patients with inflammatory bowel disease and hepatitis.
• Standardizing care pathways and ERAS for inpatients– Using consistent and proven pathways, along with the principles of enhanced recovery after surgery, improves care. Patients recover more quickly after surgery and have lower complication rates.
• Optimizing value in the OR –The OR is the single most expensive time that a patient is in the hospital. For that reason, we have highly trained surgeons who specialize in specific conditions. This way they’re doing the most efficient, high-quality surgery. We also carefully choose which patients need certain technology, such as robotics or surgery where expensive devices are used. These expensive options are not always helpful in improving the patient’s outcome ― and if it increases cost, it’s worsening the value equation, so we have to use them carefully and appropriately.

It’s a critical focus for us at the Digestive Disease & Surgery Institute to concentrate on value (meaning outcome and cost) to always improve the quality of care we provide our patients whilst making it as affordable as possible.

— Conor Delaney, MD, PhD
Chairman, Digestive Disease & Surgery Institute
Cleveland Clinic