Hospital for Special Surgery Focuses on Measuring, Adding Value

Value is the ratio of quality to cost. The delivery and measurement of healthcare quality, however, is complex. “We first need to understand and define the health outcomes that are important to patients. Then we need to put into place care pathways that will lead to those outcomes, and finally we need mechanisms to measure these outcomes,” says Catherine MacLean, MD, PhD, chief value medical officer, Hospital for Special Surgery (HSS) in New York. “To really drive improvements in quality—and hence value—the collection and reporting of these outcomes needs to be incorporated into care delivery.”

Given the importance of defining value, HSS added the position of chief value medical officer in July 2015. Dr. MacLean assumed the role, and is charged with accelerating and coordinating HSS’s efforts to deliver high-value healthcare and put mechanisms into place to routinely measure and report that value.

HSS already has a long history of delivering the highest quality care for musculoskeletal diseases, which it has accomplished in part through extensive use of clinical registries that include patient-reported outcomes. In her role, Dr. MacLean is working with HSS staff to incorporate such data into clinical practice. Simultaneously, they are building care pathways that will result in efficient care delivery.

On the cost side of the equation, high quality will produce cost savings by reducing adverse events and unnecessary care. Additionally, everyone needs to be responsible stewards of all healthcare dollars by delivering high-quality care in the most cost-efficient way.

Improving Value for Rheumatology Patients

Dr. MacLean

Dr. MacLean, who is a rheumatologist, says her experience in dealing with complex diseases that affect multiple organ systems and require care from across different medical and surgical specialties and sites of service gives her an appreciation of the many clinical elements that affect the quality, cost and value of healthcare.

“Rheumatologists think in terms of the treatment of a condition and understand the importance of care coordination—concepts that are key to producing high-value care,” she says. Additionally, as a rheumatologist she is familiar with the concept of patient-reported outcomes and directing treatment to align with patient preferences—which is also key to delivering high-value care.

As efforts get underway, the short-term goal is to get defined outcome measures incorporated into patients’ electronic health records and to move forward from there. “We will use disease-specific outcome measures, as well as a general health measure, that are the same for all HSS patients, regardless of underlying disease,” she says.

Specific Initiatives

Michael Lockshin, MD, a rheumatologist at HSS, and Shanthini Kasturi, MD, a third-year rheumatology fellow at HSS, are working to design value measurement systems to help patients with chronic rheumatic diseases. The systems apply both to individual patients and entire rheumatic disease clinics.