Using value-based analysis to influence outcomes in complex surgical systems

Area of Science:

• Healthcare Management
• Surgical Quality Improvement
• Health Economics

Background:

• Value-based analysis (VBA) is a management strategy to assess quality/cost changes when replacing usual practice (UP) with best practice (BP).
• Its utility in complex systems like cardiac surgery was previously unestablished.
• VBA was applied to address deficiencies in cardiac surgery at Memorial Healthcare System.

Purpose of the Study:

• To evaluate the effectiveness of Value-based analysis (VBA) in improving quality and reducing costs within a complex cardiac surgery system.
• To determine if VBA can successfully identify and rectify deficiencies in a high-risk surgical setting.

Main Methods:

• Cardiac surgery was identified as a suitable complex system for VBA due to available quality metrics (Society of Thoracic Surgeons) and cost data (CMS).
• Deficiencies in patient selection, surgical procedures, post-operative care, follow-up, and cost control were analyzed.
• Usual practices (UP) were systematically replaced with best practices (BP), involving significant operational and staffing changes.

Main Results:

• Implementation of best practices led to significant reductions in readmissions, complications, and mortality (p < 0.01) between 2009 and 2013.
• Memorial Healthcare System achieved a Society of Thoracic Surgeons 3-star rating in all measured categories, outperforming 98.3% of database participants.
• Despite quality improvements, cost per case and length of stay decreased, resulting in $10.4 million in actual savings.

Conclusions:

• Value-based analysis (VBA) proved effective in enhancing value (quality/cost) within a complex cardiac surgery system.
• The study demonstrates VBA's potential as a powerful tool for quality improvement and cost containment in healthcare.
• Successful implementation of VBA led to superior clinical outcomes and significant financial savings.