An Overview of the Value-Based Marketplace - Episode 1

Introduction and Defining Healthcare Consumerism

Michael Thompson: Hello, and thank you for joining this The American Journal of Managed Care® program titled, “An Overview of the Value-Based Marketplace.” Organizations have often failed faced a lack of proper performance targets, because of unclear or unaligned goals in creating value. Value-based management [VBM] tackles this problem head on. The value of a company is based on capital at returns exceeding the cost of that capital. VBM focuses on companies aligning major strategic and operating decisions. Our expert panelists will share their insights and provide a better understanding of the value-based marketplace.

I am Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. Participating today on our distinguished panel are Dr Andrew Crighton, chief medical officer of Prudential Financial, Inc; Patricia Haines, executive vice president and chief benefits officer for the Board of Pensions of the Presbyterian Church; and Dr Bruce Sherman, chief medical officer for the National Alliance of Healthcare Purchaser Coalitions. Thank you so much for joining us. Let’s begin.

I’m going to start the conversation focusing on healthcare consumerism. And just as background, in the late 1990s there was somewhat of a backlash against managed care in the industry. And toward the turn of the century, there was a very significant shift toward healthcare consumerism. Pat, can you set that up? Why did we go to healthcare consumerism? What were we trying to achieve as we went to healthcare consumerism?

Patricia Haines: Well, it seems to me that we left healthcare totally in the hands of the providers and that patients were just passive participants instead of active participants in their care. So I think the movement was really about equipping patients with information—and that’s about cost, that’s about quality—so that they could engage as stakeholders in their own health. I think the jury is out as to whether that’s really had an impact or not. I don’t know how the rest of you feel about that.

Michael Thompson: And part of that, I think, was also what happened with cost sharing, too, in that process, right?

Andrew Crighton, MD: No, I think as you look at the definition of consumerism in any other industry, you would have a clear price ahead of time, ahead of purchase. You would have a clear idea of quality. And I think some of those things are lacking in the healthcare system to really, truly call it consumerism.

Michael Thompson: Bruce, as you think about how consumerism manifested itself, what were the pieces of the strategy that you saw employers adopt?

Bruce Sherman, MD: I think that the hope has been, as Pat and Andy have described, that individuals would become more active consumers and utilize available information to make informed healthcare decisions. The problem has been the lack of transparency, as Andy described, and the challenges of individuals with respect to understanding what they need as individuals, let alone what may be available in their marketplace. Challenging their clinicians to determine what’s most appropriate for them has created a much more complicated picture of consumerism than what we had perhaps naïvely hoped.