Dr Clifford Goodman: A Look at the Present and Future of Value Frameworks

Value frameworks are tools used to clarify cost-benefit tradeoffs in healthcare decisions, which means they can look very different depending on their intended audience, according to Clifford Goodman, PhD, moderator at the ACO Coalition spring live meeting in Scottsdale, Arizona, and senior vice president and director at the Center for Comparative Effectiveness Research at the Lewin Group.
Transcript (slightly modified)
There is an ever-increasing number of value frameworks: what do they get wrong and what do they get right?
The most important thing to recognize about value frameworks is that they are popping up now. Actually, since 2014, the period of 2014 to 2015, about a half a dozen what we call value frameworks emerged into great prominence here in the United States. The most important thing is that people wanted to make more explicit the tradeoffs of benefits and costs in healthcare.
Value frameworks also recognize that value is in the eye of the beholder. Different stakeholders in the healthcare system obviously have different perspectives on what comprises value. Is it effectiveness and efficacy? Is it toxicity and adverse events? To what extent is it cost, and is it cost just of the therapy and the diagnostic itself, or is it cost savings? Is it offsets in other areas? To what extent are they long-term costs versus short-term costs?
Then there are other sorts of aspects that have come into understanding value, such as things like innovation, or are you the first therapy for an otherwise failed disease, or is this a rare condition for which this is a new therapy? Those different factors matter differently to different stakeholders, so again, the most important thing about the value frameworks is that we’re actually trying to define and assess value.
Now, as of now, they all have strengths and weaknesses, and frankly the main strengths and weaknesses are that they look different from each other. That’s actually a criticism that is not really appropriate, because these value frameworks are designed by different stakeholders with different target audiences in mind, all of which have different criteria or factors that matter differently to them.
So, I’m not so much looking or caring about the weaknesses of value frameworks right now. I’m more optimistic that we will be spending some time to see how they evolve and respond to stakeholder interest. Do the target audiences find them of use or don’t they? The best thing to realize about them now is that they are continuing to evolve. Those that develop the value frameworks are, for the most part, listening and gaining feedback and tweaking along the way. That’s my look at the current and future status of value frameworks.
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