It’s hard to believe my mother is turning 80. We talk often about her health, and her health care. She tells me, “I like my doctors because they are in tune with my needs.” “All of them?” I ask. “Yes,” she says, “They all take their time, answer all my questions, and provide all the information I need.” I’m very impressed.
More than once she has told me how pleased she was with her cataract surgeon, “Dr. S. asked me if I preferred to have better farsighted or nearsighted vision, but my friend’s doctor never told her she could choose.” Her friend had wondered why my mother didn’t wear her bifocals anymore.
Quality of Life (QOL) values
A simple option to have better farsighted vision meant my mom could pay for less expensive reading glasses instead of prescription lenses. She no longer needed to wear glasses while driving, gardening or exercising, and “no more wiping sweat from glasses.” And her farsighted vision was now amazing.
Improvements in the length or quality of life are the values to patients; in ophthalmology, that improvement is enhanced QOL through increased visual acuity. – Cataract surgery yields many values.
Cataract surgery provides seniors the quality of life to still enjoy activities like golf that provide exercise and socializing. A cost-utility analysis found cataract surgery to be extremely cost effective, providing great patient value, and a substantial financial ROI to Medicare and Medicaid – specifically, $123.4 billion over 13 years from a study in 2012.
But could there be even greater trickle-down benefits that aren’t currently being measured? Many seniors have Type 2 diabetes, and diabetes accounts for $1 out of every $3 spent by Medicaid. If cataract surgery was done earlier for some seniors, could more remain active, enjoy a better quality of life, and possibly avoid Type 2 diabetes altogether?
Dr. Charles B. Slonim shares his experience about having cataract surgery, and how it changed what he tells his patients about when to have the procedure. Normally a very conservative cataract surgeon, Dr. Slonim says that one month after his own surgery, he had examined a 75-year-old woman who has been his patient for more than 20 years, “She had developed ‘early’ cataracts that I had been monitoring for more than a decade. And this time I took an entirely different approach … I didn’t suggest cataract surgery; I insisted that she have cataract surgery. I suggested that she could benefit by seeing better to drive, but I insisted that she needed to see what I was seeing to enjoy her life better, beyond what she always had accepted as seeing ‘just fine’.”
Measuring outcomes that matter to patients
In ‘The Strategy that will Fix Health Care”, Michael Porter and Dr. Thomas Lee, say, “In health care, the overarching goal for providers, as well as for every other stakeholder, must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.”
Michael Porter describes a three-tier system for measuring outcomes that matter to patients.
- Tier 1 involves the health status achieved for a particular condition – not only mortality rates, but also functional status. For example, prostate cancer patients are concerned about incontinence and sexual functions.
- Tier 2 outcomes are the nature of the care cycle and recovery after care. High readmission rates and frequent emergency-department visits frustrate both providers and patients, and are expensive. Patients are concerned about discomfort, and being able to return to activities. They are frustrated by delays to see a specialist or commence treatment. Patients whose care is free of unnecessary setbacks experience much better care even when functional outcomes are equivalent.
- Tier 3 outcomes relate to the sustainability of health. For example, a hip replacement that lasts 15 years is superior to one that lasts two years.
Failure to improve value means, well, failure. – Michael Porter
Healthcare leaders need a farsighted strategy for the value of care – measuring what matters most to patients and providers. Farsighted leaders have vision, but they also have the ability to change intent into action. And that’s what counts.
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