The 2014 Moreton Lecture focuses on the principles of delivering high value in health care.
Michael E. Porter, Bishop William Lawrence University Professor at Harvard Business School in Boston, presented his much-anticipated Moreton Lecture, "Value-Based Health-Care Delivery." Porter focused on the challenges to radiology and the principles of delivering high value.
Many challenges face radiology, including commoditization, self-referral among nonradiology specialties, and declining reimbursement, he noted. To combat these challenges, radiologists must shift their perspective away from delivering health care in silos, an unsustainable approach that has evolved in the United States and across the globe.
"The number one goal of any health care system is to deliver the maximum value to the patient," Porter said. But how do we measure value? Porter suggested that value cannot be measured for a hospital or even a radiology practice. "We have to measure value by the set of outcomes that matter to patients," he said. To do that, he continued, radiologists must become more involved in focusing on the patient and the entire health care value chain.
Porter described four different principles of delivering high value. They are as follows:
Organize care around patient medical conditions. Porter defined medical conditions as an interrelated set of patient medical circumstances that are best addressed in an integrated way. He noted that care for medical conditions should be defined from the patient's perspective, involve multiple specialties and services, and be centered around the most common co-occurring conditions and complications.
Measure outcomes and costs for every patient. "If radiology is going to change the tide of scrutiny and suspicion associated with the specialty, you are going to need to tie what you do to outcomes," Porter said. He also noted that when physicians hear "costs," they equate it with "charges." To measure the true cost of patient care, studies must look at how costs are reflected across the entire care chain.
Move to bundled payments for care cycles. Porter proposed that the future of health care and the value of radiology would be best demonstrated if a single price covered everything within the care cycle, which covers the patient's entire disease experience.
Integrate care delivery systems. "We are going to see delivery systems much more integrated," Porter said. Moving to such systems is difficult because "everyone wants to be in charge of everything," he continued.
"At the moment we have an unsustainable model," Porter concluded. "We've got ourselves in a situation that is not good for any of us. We have to redefine our value for the patient."