A Model to Determine Value of Care Delivered at the Level of Individual Providers in an Organization

Value in health care has been defined as health outcomes achieved per dollar spent. The concept of value is a shift from the traditional volume-based health delivery system. The implementation of value-based health care has generally been at an institutional level. The objective of our study was to calculate and compare the value of health care delivered by nine individual surgeons at a single institution for laparoscopic cholecystectomies, at the level of the provider.

Data were collected for laparoscopic cholecystectomies performed over 2 years from January 1, 2016, to December 31, 2017. Only elective cholecystectomies performed for noninflamed gall bladder were included in the analysis. Any patients admitted through the emergency department were excluded. Patients who had comorbidities requiring further workup after admission were also excluded. To the best of our knowledge, there is no published model for determining value at the level of the provider. Hence, we devised a formula to determine the value of health care provided by individual surgeons based on outcome 30 days after laparoscopic cholecystectomy: Value = Positive outcome score/Cost of care.

A total of 1840 cholecystectomies were performed by nine surgeons in the study period, out of which 1402 met the selection criteria. There was a significant variation in the value provided by different surgeons according to our model.

Our proposed model differentiated the value provided by individual surgeons. Validation of the model on prospectively collected data is the way forward. The key points are: (1) There is a shift from volume-based healthcare to value-based healthcare (VBHC). (2) There is paucity of data about value provided by individual providers. (3) We propose a method of calculating and differentiating value provided by individual providers.