Ď㽶ĘÓƵ of Utah Health today announced results of the , a landmark study that examines the viewpoints of patients, physicians and employers—three stakeholder groups that directly receive, provide, and pay for health care. The study explores how these groups perceive value and prioritize its components of quality, service and cost.
The national survey of 5,031 patients, 687 physicians and 538 employers, commissioned by U of Utah Health and conducted by Leavitt Partners, indicates that conceptually, while most stakeholders agree our health care system must deliver value—what that means concretely is unclear. Several key misalignments as well as surprising points of convergence were revealed, begging an obvious but overlooked question: Without clarity on how patients, physicians and employers define “value” in health care, how can we move forward?
“If we agree as a country that we must provide higher quality health care, a better patient experience, and at a lower cost, then we all need to understand these different viewpoints and definitions,” said Dr. Bob Pendleton, U of U Health’s chief medical quality officer. The Value in Health Care Survey makes clear some of the specific ways we lack shared perspectives but also suggest points of convergence that can be used to map a path forward. Both are vitally important in creating a collective vision of how to achieve a value-focused health care system.”
The Value in Health Care Survey sheds important light on which groups patients, physicians and employers believe are most directly responsible for ensuring high value care and for keeping costs low.
Following are the key findings of the Value in Health Care Survey
When asked to choose five statements that reflected what they value most in health care 90% of patients selected different combinations of “value statements” than any combination chosen by physicians.
For patients, there was only one clear top value statement and it related to cost: “My out-of-pocket cost is affordable.” The remaining top nine statements comprised a mixed bag of cost, service, and quality statements ranging from “I’m able to schedule a timely appointment” to “The wait time at the office is reasonable.” Physicians had a clear “top five” statements as an indicator of high-value care—mostly focusing on quality and service measures.
Intriguingly, one-third of patients assigned responsibility for keeping out-of-pocket costs low to themselves while another third assigned responsibility to insurers/brokers. Only a handful of patients chose physicians or employers. Physicians, by contrast, held insurers/brokers most responsible and patients the least, while a third of employers selected themselves. The remaining two-thirds selected insurers and health systems.
Across the value statements, neither patients, physicians nor employers assigned responsibility to the employer, suggesting they don’t recognize the impact that employers have on employees’ health via the medical benefits plans they offer.
Notably only 32% of patients chose “My health improves” as a top priority—a startling statistic for physicians who are trained to prioritize clinical outcomes as a key measure of value. This finding suggests that providers will have to better address access, convenience service and cost when determining value.
Physicians overwhelmingly hold themselves responsible for ensuring that a patient’s health improves while patients equally hold themselves and physicians accountable. This suggests that physicians need to adopt a “team sport” approach to align themselves more closely to patients’ vision of value, and consider all stakeholders—systems, payers, employers, patients and providers—as jointly responsible for ensuring high value care.
There was striking consistency in patient responses across political affiliation—across almost all aspects of value. For example, 85% of Republicans and Democrats either strongly or somewhat agreed that they think the cost of health care in this country is too high; 69% of Republicans and 71% of Democrats said they were extremely satisfied or somewhat satisfied with the price they personally paid for health care in the past year, tabling a very important question: “What exactly is at the root of the policymaking divide over health care reform?
In conclusion, a better understanding of how value in health care is perceived differently across groups is imperative to achieving a value-focused health care delivery system. The results of the Value in Health Care Survey should prompt valuable conversations that will help advance health care transformation in a meaningful way.
Additional Findings
Cost
While all groups overwhelmingly agreed the U.S. spends too much on health care, surprisingly, a majority of patients and employers responded they were somewhat or extremely satisfied with what they personally paid for health care in the past year (including monthly premiums, deductible, co-pay, co-insurance, prescription drug costs, etc.). In contrast, only 37% of physicians were somewhat or extremely satisfied with the price their patients paid.
Relatively few physicians identified controlling cost as a top indicator of high-value care; however, when asked what they consider most when making decisions about treatment, only 24% noted they didn’t consider cost at all and 59% say that it is their responsibility to discuss costs with patients. This is surprising considering few tools exist that allow physicians to consider cost at the point of care.
Quality
Fewer than half of physicians and consumers and slightly more than half of employers consider the overall quality of health care in the U.S. as the best in the world. However, an overwhelming majority of all three groups are personally satisfied with the quality of the care they’ve received or provided.
Service/Patient Experience
Although service/patient experience was selected by just 12% of patients and 7% of physicians, almost half of patients’ and physicians’ top statements were service-oriented.
All three groups overwhelmingly expressed they were somewhat or extremely satisfied with the current level of service, or patient experience, in health care.
Patients tend to conflate quality and service measures, meaning if patients thought a value statement indicated good service, they also thought it indicated high quality. In other words, there are not clear definitions of quality and service, but rather patients are measuring quality in terms of service.
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Value in Health Care Survey Methodology
The Ď㽶ĘÓƵ of Utah Health partnered with Leavitt Partners to conduct online polls of patients, physicians and employers between late May and mid-July of 2017. 5,031 patients reflecting U.S. demographics, 687 physicians representing primary care and specialties, and 584 employers of various sizes, industries and sectors, were surveyed.