Elizabeth Teisberg, co-creator of the idea of value-based health care strategy and an internationally recognized author and professor, is joining the Dell Medical School at The University of Texas at Austin.
What will be the focus of your work at Dell Medical School?
My passion is redefining care delivery to create dramatic improvement in health results for individuals and families, and thus for communities. At the Dell Medical School, I will work on transformative strategies, new business models, meaningful measures of results, and innovative curriculum to enable better health and better care.
I’ve spent the past ten years working with organizations throughout the US and internationally on implementation of value-based strategy for health care delivery. This work involves helping design, deliver and measure results of services for individuals and families with particular health risks, such as families with a child with asthma, or women at high risk for heart disease, or people with colon cancer.
What in particular attracted you to this new role?
With your co-author, Professor Michael E. Porter, you wrote the foundational book on health care value. Redefining Health Care—Creating Value-based Competition on Results has changed the conversation on health care reform. Would you describe the book’s impact?
The conversation about the future of health care has changed significantly since Redefining Health Care was published in 2006. Improving value is the accepted, shared goal today. When it was first published, the idea of value was ridiculed as utopian and impractical. Physicians and other clinicians, however, have championed the need for transformation to value-based strategy because it makes health care delivery about improving health, quality of life and dignity of death.
The challenge is to put into practice the necessary strategic, cultural and measurement transformations to create consistently high and ever-improving health care value for patients and families. Dell Med’s vision of an inclusive ecosystem of health and care services can demonstrate and accelerate the needed transformations.
What do you mean when you talk about value?
The goal is improving results for patients – meaning better outcomes and lower costs. Value in health care is created by achieving meaningful health outcomes for individual patients and their families. But costs cannot be ignored – high costs limit how many people can be served. So measuring value means looking at the improvement in a person’s health outcomes for the money spent to achieve that improvement.
The value perspective is powerful. While previously the usual presumption was that the nation must spend more or impose tighter limits on health care, creating higher value opens the opportunity to enable better health for more people with the same resources.
The outcomes that matter, of course, are multidimensional. So the concept of value is not an equation. Instead, it is a powerful compass to drive clinical improvement, enable patients to make decisions consistent with their own priorities, and measure progress at the level that matters most – the help that health care provides to individuals.
Can you give us a couple of examples of improving value?
Sure. It is inherently less expensive to live in good health than to live in poor health. When we successfully work with patients to reverse type 2 diabetes, they avoid both the poor outcomes of disability, amputation or kidney failure, but also the high costs of care for those problems. When we help people with migraines to prevent the triggers or onset of pain, the results are not only less pain, more engagement in their lives and more days at work, but also fewer expenses of managing chronic illness. There are myriad untapped opportunities.
Health seems hard to define. What outcomes should be measured?
In my work with Scott Wallace on implementing value-based health care, we have found three categories of outcomes that go a long way to defining success with health: capability, comfort and calm. Capability addresses the question of the frequency or degree to which you can do the things that matter to you: go to work, walk up the stairs, lift your child, see well enough to read, etc. Comfort addresses physical and emotional pain – whether your pain is getting better or worse. Calm addresses the interruption of your life as you pursue health care: is your life being overtaken by appointments, side effects and the chaos of fragmented services? This framework helps patients and their care teams track improvement or decline in health outcomes for every patient over time in ways that support the aspirations of both patients and health care professionals.
So there are multiple outcomes that matter to patients and families?
Absolutely. Value has multiple dimensions. For example, patients with head and neck cancer often care deeply about retaining the ability to swallow and the ability to talk, about not being in pain, and about spending as much time as possible with their families rather than in hospitals and doctors’ offices. These outcomes cannot be added together. Both the clinical team and the patient need to be able to consider them as distinct issues.
Is patient experience part of value?
Yes. We find that measuring outcomes during care provides deeply meaningful information on the patient experience. People seek health care to improve their health, so measuring what matters most means measuring more than parking, wait times or even satisfaction with the doctor’s demeanor. We look at relief of pain and emotional suffering during the care experience; improvement in capabilities; and the calm (or mayhem) that health care can create that adds to or detracts from the time one can spend on preferred activities during the care process.
In a service-oriented business, the drivers of a positive experience depend on the nature of the service. From a five star hotel, you desire lasting memories. From your favorite restaurant or pub, you may want to while away the hours. From a theme park, a wild ride is a great experience. But lasting memories, whiling away the hours and a wild ride do not capture the essence of great health care.
Isn’t it simpler to just ask if the patient would recommend this doctor?
It is popular now to try to condense experience measures into one net promoter score that reflects whether or not patients would recommend a doctor or hospital. Such scores provide some information, particularly when they are bad. But net promoter scores provide no information for clinical teams on how to improve. Also, when patients are getting ongoing care for a chronic long-term condition, they have strong incentives not to offend their caregivers. Worse still, this measurement approach fundamentally asks the wrong question. It asks the provider-centric question, “How were we?” when the whole point of health care is to improve the answer to the patient-focused question, “How are you?”
What about doctors and nurses and other clinicians?
The raison d’etre for health care is serving patients and families. Value creation for these individuals is the fundamental goal of health care professionals. By focusing explicitly on value for patients (and for healthier people who aren’t patients in the acute sense), value-based health care strategy supports professionalism.
When Mike Porter and I published our first article on why value for patients needs to be the goal, I received a flood of 38,000 emails in two months – most of which were from physicians who were excited that we were writing about what really matters to them.
Teams and individuals that measure meaningful health outcomes for patients see the differences they make day-to-day and year-to-year. Job satisfaction and even financial success can then align with the intrinsic motivation that led these professionals to choose health care careers in the first place.
Setting value for patients as the goal assures that clinicians can measure success in terms of the help they provide with health, not whether the parking was convenient or the hospitality services were good.
What is your vision for what’s possible as we “rethink health care” in Austin?
We have opportunities to transform health and care in Austin in ways that drive ongoing improvement in value for patients and families, and we can accelerate this transformation nationally and internationally.
Dramatic improvement in health care value replaces the tyranny of the “or” – spend more or limit more – with the opportunity to achieve better health for more people by improving outcomes in ways that reduce costs. Only by improving value in health care will we be able to afford better health for all.
What benefits do you expect your work, and the work of Dell Medical School, to provide to the people of Austin and Travis County?
Historically, either health care strategy was entirely neglected or it focused on increasing the volume of expensive acute care treatments. Value-based health care strategy addresses the full cycle of health, with much more attention to care at earlier stages. Our opportunity is to design services that help people achieve and sustain better health.
I should add, I’m new to Austin, and I’m loving it!
What are you most excited about as you join the Dell Med team?
The Dell Med Team is exciting because it aspires to transform health care to achieve better health for far more people. One of my mentors, Dr. Jim Yong Kim, likes to say that the real problem with health care is that aspirations are far too low. Low aspirations limit achievements in health and care. Dell Med aspires to create a high-value health care ecosystem and a healthy community. High aspirations are inspiring.