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