Patient-level Value Analysis: A Model for Implementing the Concept of Value-based Healthcare Into Clinical Practice

As interest in incorporating value-based healthcare (achieving better health outcomes for patients relative to costs) into clinical practice and policy expands, there is a growing need for a well-understood and easily implemented methodological approach. Patient-level value analysis (PLVA) quantifies patient outcomes (using patient-reported outcome measures [PROMs]) in the context of total costs of care (using time-driven activity-based costing). When both aspects are paired, optimal value is achieved. There are six steps to perform PLVA: (1) defining the care pathway, (2) identifying low- and high-value interventions, (3) defining PROMs of interest, (4) determining costs, (5) evaluating the relationship between PROMs and total costs of care, and (6) identifying potential value drivers. This approach equips users with information on how to minimize variation, implement best practices, and encourage the delivery of high-value care. The primary objectives of this article are (1) to compile a synthesis of PLVA literature and (2) to use the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework to provide orthopaedic surgeons with tactical guidance for implementation of PLVA.