An earlier blog discussed the potential for the Perioperative Surgical Home (PSH) model to disrupt the standards of anesthesia care. In a follow-up to that discussion, change agents in the anesthesiology community are now proposing a value-based strategy to address efficiency and patient satisfaction. In this strategy, a complex value analysis will align with the PSH model, allowing for a successful patient care episode. In-depth analyses of value across the patient journey, particularly within a collaborative approach, are essential to the next frontier of high-quality anesthesia care.
In discussing a value-based approach to anesthesia care, it is necessary to introduce the concept of a “value chain”. As described by PSH expert and surgeon Dr. Jimmy Chung at the American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference, the value chain is a means of quantifying a clinical pathway with respect to value. Essentially, from pre-surgery to post-operative recovery, each step on the value chain should add value in a meaningful and significant way. To evaluate value added, healthcare administrators can evaluate such measures as cost reduction, improved outcomes, decreased length of inpatient stay, fewer follow-up visits, and/or long-term population health cost offsets. Of such variables, clinical efficacy and cost offsets are the two that require the most attention, as each impact the quality of care the hospital provides as well as the resources the institution can allocate to support such care. According to experts in value-based care, if a step on the value chain is not additive, it ought to be eliminated. Pain management is often a crucial additive factor for value in the perioperative patient journey. If an anesthesiologist and/or Certified Registered Nurse Anesthetist (CRNA) can support preemptive management of the patient’s recovery post-surgery, employing such tools as glucose management and infection prevention, then the likelihood of the patient not returning to the hospital increases on a dramatic scale.
Anesthesiologists, CRNAs, and healthcare administrators alike each have roles to contribute in this aim. One concrete way in which all three can support a value-based approach to anesthesia care is in product selection. Traditionally, healthcare administrators engage in contracting discussions with supply manufacturers; such discussions are typically siloed from practicing clinicians. However, a modern take on patient management recognizes that clinicians often have the highest level of direct experience in product utilization and thus their opinion is essential to moving towards an appropriate solution. For example, anesthesiologists and CRNAs can provide real world experience of the tools, products, and medications that they utilize on a daily basis. By seeking such input and increasing clinician presence in the decision-making process, healthcare administrators can ensure that contracting with manufacturers reflects the actual practice needs of clinicians, thus minimizing excess. Moreover, healthcare administrators involved in surgical and anesthesia management can advocate for a value-based approach to care by proposing value-based contracting with manufacturers. Value-based contracting is an approach to contracting in which the hospital’s compensation to the manufacturer is dependent on the performance, utilization, and/or outcomes of the product in a surgical setting. Such tools are highly effective in promoting value across clinical specialties and patient populations alike.
In sum, the increasing importance of value will be crucial to the development of anesthesia management. Anesthesiologists and CRNAs should be prepared to work in tandem with healthcare administrators in order to refine a clinical pathway that ensures value at each step of the way and results in the highest level of excellence for the patient and hospital together.
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