HEALTHCARE’S BIG QUESTION: VALUE OR COST? RAYMOND RUPERT MD. MBA.

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There is a revolution occurring in healthcare spending. The focus is on value for healthcare dollars that are spent.  Healthcare systems want to pay for value and not for volume.

When Professor Michael Porter, strategy professor at Harvard Business School, analyzed healthcare systems about a decade ago, he concluded that competition was highly dysfunctional.

He posited that competition based on value was what was needed.  Porter defined value as the best outcome possible at the lowest cost.

He wrote about the need for value based competition in his landmark 2006 book “Redefining Health Care”.

This focus on value has lead to Value Based Insurance Design (VBID) and the flip side of that equation- Value Based Care.  Health insurers want value not volume.  The focus is clearly on delivering value per dollar spent.

Many healthcare systems are preparing for pay for performance. This improves the paradigm for the consumer and society.

Case Study Illustrating Value Or Cost:

In 2006, a 62 year old Canadian male had a 2 artery heart bypass procedure.  The surgeon used the patient’s right radial artery (from his arm) and his left internal mammary artery (from his chest) for the bypass. Arteries are longer lasting and more durable pipes compared to veins.

In Feb 2014, he was in Florida and developed chest pain. He went to the local emergency department. They ran some tests and immediately did an angiogram. The angiogram showed a kink at the origin of the radial artery bypass and a 50% lesion. The cardiologists put metal stents in both areas.

Then they told him that he should come back to Canada and have his chest opened to replace the radial artery bypass.  He was, understandably, upset.

Here Is What Happened:

The client retained Rupert Case Management Inc. (RCM) to provide expert advice. We put together an expert panel with a leading cardiac surgeon and a very experienced interventional cardiologist.  RCM’s team reviewed the Florida angiogram.

RCM’s experts concluded that the kink at the origin of the radial artery bypass and the 50% lesion were not problematic because the flow south of the radial artery, to quote the cardiac surgeon, was like a “fire hose”.

Here Is The Bottom Line:

The procedure of placing the two metal stents in an adequate radial artery was not providing value. The stents were costly but without clinical utility or benefit.

This was a case that would have benefited from a “real time second opinion” from RCM’s expert panel. The second opinion might have saved the health care system $20,000 to $30,000.

Our client is very pleased that he does not have to do anything further. Now he can focus on enjoying his very active life.