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The state of value in US healthcare [PODCAST]

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The Hospital Finance Podcast

In this episode, Amy Albo, Publisher at the University of Utah, discusses a national survey that looks at value in health care from the patient, physician and employer perspective.

Learn how to listen to The Hospital Finance Podcast on your mobile device.

This podcast discusses key findings from a University of Utah study that examined the perceptions of healthcare value among patients, physicians, and employers, including:

  • The misalignment of what stakeholder groups value most in health care.
  • How patients and physicians view value differently.
  • For patients and employers who provide medical benefits, improving health is not the most important metric for value.
  • Patients and providers want to discuss cost as a component of providing value.

To review the study results and for other resources related to healthcare value, visit:

Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast. Today, I’m joined by Amy Albo who is publisher at University of Utah Health and co-author of a recently commissioned survey that looks at value in healthcare from the patient, physician and employer perspective.

Amy is also editor-in-chief of the University of Utah’s Algorithms for Innovation, a thought leadership initiative designed to spark conversations around some of the most impossible problems in healthcare and academic medicine.

And Amy has joined us today to talk about the survey that I just referenced a minute ago which looks at value in healthcare. Amy, welcome to the program.

Amy Albo: Thank you, Mike. Thank you for having me.

Mike: So first, tell us why you conducted this survey.

Amy: At University of Utah Health, we’ve been very focused on value for the past 10 years, different aspects of it. We created an equation, a value equation, that defines value as quality + service the patient experience over cost.

And so, while committed to value, we feel like, by many metrics, the value movement in US healthcare has been quite sluggish at best. And we’re curious why that is. And we felt that there were three voices that really haven’t been heard loudly enough at least in the policy discussions. And those are patients, the people who receive healthcare; providers, specifically physicians for this survey, the people who provide healthcare; and then employers (55% of Americans are insured through their employer). And we wanted to get out how they define value and how they perceive responsibility and the importance of it.

So, that was the basis. It was a nationwide survey of 6,000 patients, 600 physicians and about 500 employers who provide medical benefit.

Mike: So Amy, let’s just jump right into some of the key findings. And as our listeners might imagine, there is a misalignment in what these three groups value most in healthcare and who they hold responsible for making sure that these things happen in the healthcare delivery process and value is delivered. So, talk to us about that.

Amy: Yeah, we did find the surveys’ findings somewhat surprising. There were areas of alignment and a lot of areas of misalignment. And so it’s probably important to note that we wanted to break value down into really digestible, understandable pieces. Healthcare is so complicated. I think we make it extra complicated especially in the value arena where we talk about alternative payment models and value-based payments and all sorts of things that don’t mean a lot to certainly the patients.

And so, we worked with an advisory group to come up with about 18 to 19 value statements that represented different aspects of costs, quality, and service in healthcare. And then, we asked each of their audiences to say which are the five most important. And then, we looked at what was in alignment and what was out of alignment.

What we found surprising about patients was the number one chosen value statement was that “out of pocket cost is affordable.” And that was really the only sort of head-and-shoulders above the rest specifically speaking value statement there was.

And then, there was a whole list of about eight other value statements that kind of came in the 30’s percentiles. And they range from “I’m able to schedule a timely appointment. The office is conveniently located” to quality metrics like “The provider knows and cares about me. I’m confident in their expertise.” And then, interestingly, eighth on the list was “My health has improved.”

So then we contrasted that to what physicians value most. And their top five really dealt with quality and service aspect: “I know and care about the patient… I ordered the appropriate exams… the patient’s health improved.” So, they’re really focused on quality and service metrics which is really how they’ve been trained and I think they would agree is the most important thing to focus on.

But then when you align that with what the consumer thinks is important or the patient that deals with convenience and friendly staff—“The staff were friendly and helpful” was slightly above “My health improves”—then we start to see this disconnect . And if you think about physicians in their office every day, having patients coming in with a whole different idea of what defines value in healthcare or is a high value experience, then you can see where some of these disconnect happens.

Mike: And that’s certainly got to be disconcerting because these days, physicians are paid in part at least based on some of these quality metrics, whether it’s through a Medicare-type program or perhaps through private payers. But that’s certainly something that would be on the minds of physicians I would think.

Amy: Absolutely! And so, we’ve taken these survey findings and talked to a lot of people who had focus groups with patients and physicians and employers to try to understand and unpack the data. And one of our surgical sub-specialists looked at the data and said, “This is going to be very upsetting to physicians because here they spent literally decades or many years training with really the focus on providing the most high value care, the best outcomes”. And then, to think that patients are ranking some of these other things higher than that is upsetting.

Mike: So let’s talk about employers a little bit. So you found the survey for patients and employers who provide medical benefits improving health is not the most important metric for value, suggesting that providers will need to prioritize access, convenience, service and cost. And you alluded to that a minute ago, but I’m curious to dig into the employer side of that equation.

Amy: So, we tried to develop a statement that correlated. They were slightly different for the employers. And what’s interesting to note about the employers is when we asked sort of “What do you value most in healthcare?” we had a different employee productivity was the correlation for quality cost or employee satisfaction was sort of service. And they said employee satisfaction was highest.

But then when we broke it down into value statements, really, their clear top two statements dealt with costs—the cost of employee is affordable, the cost of the company is affordable.

So, again, it shows sort of a disconnect or misalignment. I mean, it’s no surprise that employers would be focused on cost. But that also creates another sense of misalignment between the providers and the patients and the employers.

Mike: Yeah, what was interesting, another one of your key findings around cost is that the survey found that stakeholders are aligned about the desire or the feeling of responsibility for providers and patients to have conversations about the cost of healthcare. So it’s on the mind of both sides of the equation. Talk to us about that.

Amy:  Yeah, that was interesting. So we asked a number of different questions around cost to sort of create the narrative. So we asked interestingly, “Do you think the overall cost of healthcare in this country is too high?” And overwhelmingly, 83%, 89%, 84% of patients, physicians and employers all strongly and somewhat agree that the cost that we’re spending as a country on healthcare is too high.

But then we asked “How satisfied generally are you with how much you’ve paid” or “…how much you’ve had to charge?” And interestingly, patients and employers were 67% and 71%. They were fairly satisfied with what they’re personally paying. And physicians were the least satisfied with how much they’re charging their patient. Thirty-seven percent said they were somewhat or extremely satisfied, 32% are somewhat dissatisfied and extremely dissatisfied.

So, this idea that physicians don’t care about cost, the survey would suggest otherwise.

And then, we asked, “Would you like your healthcare provider to talk to you about the cost of your care?” And 60% of patients said they would. Yes, the physicians do think it’s their responsibility to discuss the cost of care with patients. Fifty-nine percent said they did think that was true. And then, 71% of employers said, “We’d like healthcare providers to talk with our employers about the cost of their care.”

So, that is actually a point of alignment. Patients want to talk about costs. Certainly, employers want to have that conversation. And nearly 60% of physicians said they felt it was their responsibility.

Now, what we don’t have of course are the tools at the point of care to be talking about that nor maybe have we designed reimbursement or clinic flow models or the time to talk about that.

But if we think generally about what came out of this survey, somewhere where we could work toward a unified vision of value, I think that clearly shows it’s one of them.

Mike: And it’s a fascinating study. If someone would like to get a copy of it, where can they go?

Amy: They can go to our website at You can also just google “UofUHealth value survey.” We would love to share the data. We have so many cross-tabs. And we feel like this is a really important conversation.

If there’s one thing that we can all agree upon in healthcare—and there isn’t very much of it—it’s that high quality patient-centered care that’s affordable is what we should be working toward.

And so, to the extent that these findings could help move toward that, we would love to share them.

Mike: Amy, thanks for stopping by today on the Hospital Finance Podcast.

Amy: Thank you, Mike, for having me.


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