Values-Driven Care Management
One of the current buzz phrases in the field of health care is value-driven health care. It refers to the goal of optimizing quality and efficiency within the health care system. Value-driven health care is increasingly a major factor in pay-for- performance incentives to providers (Fink, 2008). While at first glance value driven health care seems laudable, system-centric goals may not always be aligned with specific patient needs or desires. Of the over 600 performance measures endorsed by the National Quality Forum (NQF, 2016), only 87 focus on patient experience. Furthermore, NQF has identified 254 measurement gaps that are not currently addressed but that may have a profound impact on whether a patient experiences a positive outcome. Major metric gaps exist in the areas of care coordination, communication among providers, autonomy and self-determination of patients, connection with community resources, person/family centered communication, and shared decision making and care planning. A Professional Care Manager can bridge the performance gap in many of these areas, transitioning value-driven health care to alues-driven care management, with emphasis on patient values as the cornerstone of the care planning. Care managers are skilled in facilitating communication among health care professionals and in navigating the variety of available community resources. More importantly, professional care managers advocate for patient autonomy and infuse patient self-determination into health care decision process. Finally, care managers promote patient-centric care when it conflicts with system-centric care.
Fink, K. (2008) Value-Driven Health Care: Proceed With Caution. Journal of the American Board of Family Medicine. vol. 21 no. 5 458-460, doi: 10.3122/jabfm.2008.05.
National Quality Forum, Report to Congress, March 2016