WHAT YOU CAN EXPECT
Who My Clients Are
My clients are companies who have a product, device, process, or system that serves as a “solution” to some specific problem within healthcare. These problems can be related to care delivery, patient outcomes/experience, effeciency/cost, or something else. And, these organizations want to demonstrate the value of their solution in order to achieve a goal that is often one of the following types:
- to acquire or increase funding or investment (private or federal)
- to increase revenue, sales, market size, or something similar
- to be acquired by another organization
Depending on the type of goal, the audience for that organization’s value demonstration differs (investors, users, an acquiring organization, respectively), but all my clients also typically have to consider multiple perspectives when assessing value, like those of payers, providers, and patients. Therefore, while the specific needs are unique for each client, there are some commonalities across all clients.
Regarding value demonstration, we can think of an organization’s journey as involving multiple stages from conception to scaling or acquisition (the left side of the figure below). Within each stage, there are certain milestones (the checkboxes in the figure below) that commonly occur throughout these stages.
If you consider this (admittedly simplified) model as well as the common types of goals listed above, you can probably get a feel for which stages my clients typically find themselves in when we begin.
Now, the positions of the milestones across the stages are relatively fluid, and some might appear in multiple stages for some organization. For example, the milestone “Have CVP-like materials” appears next to the stage for Stage or Acquisition, but it is likely that the organization will need to begin to develop these materials in the Growth or even the Early Sales stage.
Most of the time, my clients can check off the first 6 or 7 milestones (starting from the bottom) by the time we connect. Some may have checked milestones all the way through the Early Sales or into the Growth stage. However, they often have a few gaps along the way, and most feel like they need some help thinking about how best to identify, quantify, and describe the value of their solution.
How an Engagement Typically Goes
A full engagement typically involves multiple related steps described in the figure below. The first two steps, “Establish initial strategy” and “Gather information,” are the beginning and as the arrows indicate, they are iterative. That is, we begin with some notions of the potential value, its sources, who benefits, etc., but we need to validate that with what data and research tells us. During that process, we may learn how to improve our original strategy or identify it as unviable and need to establish a completely new strategy. The result of these steps will be specific information for the internal team members regarding how value is created or captured, by whom, and through what means. Sometimes we will even formalize this as a written summary report with tables and figures.
Once we feel we have an initial strategy that is supported by the information gathered (published literature, data, research, etc.), we move on to the next two steps. These, too, are iterative. We develop one or more value messages for a specific external audience and then create tangible materials (like white papers, economic analyses, value briefs, slide decks, etc.) that can be used to communicate those value messages to those specific audiences. During their creation, we may refine the value messages or even identify new ones that require their own materials.
The final step involves maintaining and revising the relevant information and materials as needed. This commonly occurs when we get new information or feedback from the intended audiences (e.g., maybe a payer feels a certain estimate or assumption we use should be adjusted, or new research emerges, etc.). This may involve updating existing materials or it may involve developing new materials, new value messages, or even new strategies.
However, at the center of all of this we will always keep your desired goals or outcomes as our guide. Ultimately, the point is to help you achieve those goals, not to produce specific deliverables. Therefore, fees are never based on time or deliverables, but instead are based on your goals and desired outcomes. Therefore, fees are unique to each organization and their situation. During the engagement, we will spend whatever time and develop whatever deliverables we determine are necessary to get you to your desired outcome. While we will typically have an idea of what will be necessary, it is extremely common for us to change or add strategies, value messages, and CVP materials during this process. Luckily, since the engagement is not linked to time spent or specific deliverables, it is easy to switch gears and direct resources to wherever they are needed. Clients understand and acknowledge that there is inherent uncertainty in this process, but see that as a strength, allowing for flexibility and agility.
Full engagements are typically immersive and run from 6 to 18 months or more.
Why My Clients Hire Me
- They want some guidance and assistance in planning and executing a value assessment of their solution and value my experience and expertise in this area.
- They value my ability to identify and gather a large amount of information, sift through it, and pull together a relevant story of the value of their solution.
- They want to present a credible and compelling narrative of their solution that reflects their organization’s mission. That is, they are not trying to fool anyone – they want to be able to confidently speak to the value of their solution with the knowledge that hard science and good research supports what they say.
- They believe that a thorough examination of value from multiple perspectives is critical to accomplishing their future goals and are willing to invest time, attention, resources, and money to pursue it.
Regarding Value Assessments, I believe the following:
Value, as a concept, is subjective and often vague.
Quantifying and assessing value are technical endeavors rooted in theories of measurement and evaluation, where we try to define constructs, apply surrogates, and assign monetary values in order to arrive at a tangible figure. These explorations are used to motivate, justify, and/or persuade individuals or organizations to behave a certain way or to invest in specific activities intended to improve care delivery and/or patient outcomes.
But there’s more to it. As with any technical effort in healthcare, it becomes necessary to traverse the space between the purely technical and the practical or real-world situation. Value in healthcare encompasses many significant aspects that are not measurable, quantifiable, or monetizable.
This is where my mission lives. Here is the space where I operate, and I claim that this process is as much an art as a science. Because I believe you should “recognize that some of the most important things you do occur in this space, and that they require vision, creativity, and yes, even art. At the end of the day…your goal is to discover, affect, and connect.”
It is through this lens that I believe we need to consider what value assessments should be. To that end, I present five tenets I believe should be true about value assessments.
1. Value is more than the financial return.
ROI is only part of the story.
Ultimately, the motivation for improving systems of care or developing a new device or treatment is to positively impact patients. Regardless of the financial implications, much of the value of these activities stem from non-monetary benefits. There’s inherent value in good health, longevity, satisfaction, peace of mind, dignity, comfort, etc. Certainly, the financial return indicates whether an activity or change is feasible, but it is rare that one should consider ROI separately from value in the larger sense. Instead, we should interpret the financial component in light of the larger context of the situation and goals of those involved. A poor or negative ROI does not necessarily mean one should scrap the proposed solution or process; rather, it signals an incongruence between intrinsic value and financial realities. It should motivate questions like, “How do we reduce costs so that we can implement this process to help patients?” and “How can we more efficiently offer this tool that will allow providers to more acutely connect, understand, and care for their patients?” ROI serves us best when viewed as a component of value and when used to direct our attention and next steps.
2. A value assessment should seek to guide, inform, and teach.
If it’s necessary to do, then it’s not obvious.
Most likely, the intended audience for the results of a value assessment will have a deep and sophisticated understanding of the clinical and perhaps even financial aspects of the solution. Simply restating the known costs and benefits provides little insight compared with a targeted analysis that assesses specific questions or issues.
Chose to lead. Identify a specific objective and walk the audience through the various steps to that end: assumptions and estimates used, calculations made, and the understanding revealed by the process. Welcome feedback and suggestions, even debate. Regardless of the specific goals, the objective of a value assessment is often to inform concrete decisions and help shape targeted actions. Therefore, those reading or hearing the results should learn something new, think of something in a different or more comprehensive way, or consider a provocative new perspective. If that’s not possible or necessary, then ask: is a value assessment really necessary?
3. The interpretation should combine technical and practical considerations.
The assessment needs to be both credible and compelling.
Assessments that are too technical lack the ability to motivate or move the intended audience because the results can seem to abstract. As a famous statistician once said, “All models are wrong, but some are useful.” This means that even the most rigorous analysis will fail to fully describe reality, and therefore will require some translation to actual situations. At the same time, scientific rigor is needed to root the interpretation in truth. The most effective assessments are simultaneously credible and compelling.
Credibility is established through a foundation in data and scientific research. Providing a full picture of what is known about a particular clinical topic or area gives context to the assumptions and estimates made in the assessment, and minimizes the number of “leaps of faith” asked of the intended audience.
To be compelling, the assessment needs to read like a relatable story that is grounded in real experiences and considers practical constraints. Whether the story retells a real situation or whether it explores realistic hypotheticals, it needs to synthesize all the scientific information together and integrating it with real-world aspects. Here is where the artfulness of the process shines through most vividly.
4. Value assessments can demonstrate what you know to be true, but they can also identify what you didn’t know.
In addition to persuading, you can use a value assessment to explore.
We’re often reluctant to proceed without knowing the outcome in advance. We shouldn’t be. Instead of fearing uncertainty, embrace the knowledge that we will likely learn something new, even if it’s not what we had hoped. If done well, a value assessment reveals something new or even unexpected that will better equip us to understand how best to proceed.
Quality and value are linked, but quality and ROI may not be. That means that comprehensive, effective, patient-centered care is likely to be extremely valuable in the broader sense. But it may be financially infeasible to provide or sustain, implying only that you’ve yet to figure out how to align the financial incentives with the overall value produced by the care solution.
A thorough examination of the sources and magnitudes of the costs and benefits may reveal which components are critical for financial viability. Maybe it’s about volume; maybe it’s about efficient application to the right patient population; maybe it’s about leveraging technology in the right way; or maybe it’s something else completely.
5. Value assessments should not be a one-time endeavor.
Useful healthcare-related metrics should be continuously monitored, including metrics of value.
These days, those who are involved in the delivery of care understand the benefits of “dashboards,” which are a collection of multiple metrics or indicators of the quality of care delivered. Seeing key data over time to understand how and when they change is integral to making good decisions about the health and well-being of patients.
Measurements of value should be no different. To truly understand the value associated with a process, product, device, or solution, one needs to assess the value at multiple time points and monitor key metrics. Circumstances change, policies are revised, and clinical knowledge evolves. It may be best to create a dynamic assessment or knowledge base that can be updated regularly.
 As stated in my mission.
 This quote is usually attributed to George E. P. Box
American Medical Association (AMA) • Stratis Health • Oklahoma Foundation for Medical Quality • Optum • University of Minnesota • Indiana University • American Society of Clinical Oncologists (ASCO) • ICSI • Kidney Care Quality Alliance (KCQA) • Medtronic • NYU • Boston Scientific • Harvard Medical School • MPRO • Telligen • E4 Enterprise • Lee Branding • MetaStar