Value Management in Healthcare

Our current healthcare system is broken. The Organization for Economic Co-Operation and Development (OECD) predicts health care costs could increase from 6% to 14% of GDP by 2060. The cause of this increase is due to (1) a global aging population, (2) growing affluence, (3) rise in chronic diseases, and (4) better-informed patients; all of which raises the demand for healthcare. In 2006, Michael Porter and Elizabeth Teisberg authored the book ‘Redefining Health Care: Creating Value-Based Competition on Results.’ In it, they present their analysis of the root causes plaguing the health care industry and make the case for why providers, suppliers, consumers, and employers should move towards a patient-centric approach that optimizes value for patients. According to Porter, “value for patients should be the overarching principle for our broken system.” Given the current state of global healthcare, there is urgency to achieve widespread adoption of this new approach.

The updated second edition of this book discusses two major issues driving the importance of value-based care. The first is the emergence of Artificial Intelligence which has the potential to significantly impact and enhance value-based healthcare in several ways such as delivering personalized medicine, predictive analytics for patient outcomes, and improving population health management. The second issue is why value-based care continues to struggle in scaling. While value-based healthcare has shown promise in improving patient outcomes and controlling costs, there have been challenges in implementation such as transitioning from the traditional fee-for-service model, data interoperability issues and limited standardization of health outcomes. These challenges do not necessarily mean that value-based healthcare has failed. Instead, they highlight the complexities of the work involved and the need to follow a process as provided in this book.

The intent of this book is to equip all healthcare delivery organizations with a guide for putting the value-based concept into practice. With updated material and case studies, this book defines the practice of value-based health care as Value Management. The book explores Mr. Porter’s Value Equation (Value = Costs/Outcomes), which is central to Value Management, and provides a step-by-step process for how to calculate the components of this equation. On the outcomes side, the book presents the Value Realization Framework, which translates organizational mission and strategy into a comprehensive set of performance measures and contextualizes the measures for healthcare delivery.