Value Driven Healthcare

Value-Driven Healthcare Explained

Consumers deserve to know the quality and cost of their healthcare. Healthcare transparency provides consumers with the information necessary, and the incentive, to choose healthcare providers based on value.

Providing reliable cost and quality information empowers consumer choice. Consumer choice creates incentives at all levels, and motivates the entire system to provide better care for less money. Improvements will come as providers can see how their practice compares to others.

Healthcare "System"?

The healthcare "system" in Wyoming, and across America, is not a system. It's a disconnected collection of large and small medical businesses, healthcare professionals, treatment centers, hospitals, and all who provide support for them. Each player may have its own internal structure for gathering and sharing information, but nothing ties those isolated structures into an integrated system capable of coordinating patient care.

Integrated systems are invisible but essential. We have come to depend on many. When you use a cell phone to talk with a friend who uses a different cell service, you are using an interoperable system. Your ATM card is good not only at virtually all banks nationwide, but thanks to a secure integrated system, you can use it to buy everything from groceries to gasoline.

These systems work because the telephone and banking sectors have developed methods and standards that allow participants in their systems to easily access and exchange information while the companies operate independently and compete vigorously. Yet they work together to provide seamless customer service to you, the individual consumer (what healthcare calls the patient).

Cell phone providers are keenly aware of their competitor's quality of service. Banks closely monitor competitive rates. Customers are able to compare both quality and cost. Value-driven consumer choice, in turn, drives greater competition and increasingly better service.

Wyoming’s healthcare purchasers (employers) are beginning to embrace transparency; and by doing so, are creating a powerful force for change.

Transparency Leads to Change

Transparency is a broad-scale initiative enabling consumers to compare the quality and price of healthcare services, so they can make informed choices among doctors and hospitals.

Cooperation among Wyoming’s employers and the local delivery system is laying the foundation for pooling and analyzing information about procedures, hospitals and physician services. When this data foundation is in place, the Wyoming Business Coalition on Health will turn the raw data into useful information for consumers.

Why Transparency Is Important

For every other purchase that they make, consumers can easily get information about price and quality. When consumers have this information they can make better decisions. Consumers should share in the savings, in the form of lower premiums and more effective care, when they take an active role in healthcare decisions.

Four Cornerstones of Value Driven Healthcare

  1. Interoperable Health Information Technology (Health IT Standards): Interoperable health information technology has the potential to create greater efficiency in healthcare delivery.  Significant progress has been made to develop standards that enable health information systems to communicate and exchange data quickly and securely to protect patient privacy.  Additional standards must be developed and all healthcare systems and products should meet these standards as they are acquired or upgraded. 

  2. Measure and Publish Quality Information (Quality Standards): To make confident decisions about their healthcare providers and treatment options, consumers need quality of care information.  Similarly, this information is important to providers who are interested in improving the quality of care they deliver.

  3. Measure and Publish Price Information (Price Standards): To make confident decisions about their healthcare providers and treatment options, consumers also need price information.  Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers.  In addition, strategies are being developed to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases.
  4. Promote Quality and Efficiency of Care (Incentives): All parties - providers, patients, insurance plans, and payers – need to work together to develop and test programs that reward both those who offer and those who purchase


Click here to see the Purchasers Guide to Value Based Benefit Design