Guide to High-Value Healthcare: Addressing Drivers of High Costs, Uneven Quality and Health Inequities

States are Accountable

Healthcare value problems (and solutions) vary depending on a state’s unique populations and local market conditions. As healthcare regulators and payers, state governments play a critical role in helping their health systems function. Nonetheless, too few take a coordinated, systematic approach to ensuring that residents get value for the money they spend.

A small number of states have a central oversight authority that focuses on reducing healthcare costs, improving quality, bringing spending in line with overall economic growth and implementing innovations for better value. Additionally, most states lack critical data and analysis capacity needed to customize the solutions for their healthcare market. Our resources can help!

Address Social/Personal Determinants of Health

Failure to address social determinants of health is the largest contributor to wide disparities in health outcomes. Healthcare, public health and social services must work together to fully address the goals and needs of the people they serve. Our policy roadmap outlines the many policy changes needed to accomplish this goal. Examples include:

• Assess Unmet Community Needs
• Form Accountable Communities for Health
• Coordinate Care for Complex Patients  

Decrease High Unit Prices

Rising unit prices are our most important cost driver, accounting for the majority of year-over-year increases in per capita medical spending. Strategies to lower unit prices include:

• Price Transparency Combined with Quality Transparency
• Increase Provider Competition
• Rate Setting/Price Regulation 
• Global Budgets

Reduce Waste

Contrary to popular belief, high utilization of services does not drive our high healthcare spending. Nevertheless, evidence is clear that many services could be eliminated with no harm to patients -- saving money. At the same time, increasing the use of high-value services -- like tobacco cessation, flu vaccines and certain preventive screenings -- improves outcomes and saves money down the road. Strategies to reduce waste include:

• Financial and Non-Financial Provider Incentives 
• Financial and Non-Financial Consumer Incentives 
• Reduce Administrative Waste

Improve Health Outcomes/Increase Equity

All of the strategies above will contribute to better health outcomes for consumers. But additional steps should be taken to ensure that all people have equal opportunity to lead healthy lives. Strategies to make our healthcare system more equitable include:

• Address Provider Shortages
• Increase Diversity of Providers
• Anti-Oppression/Equity Training for Providers
• Align Quality Targets across Stakeholders

Ensure Care is Affordable

Addressing social/personal determinants of health, decreasing high unit prices, reducing waste and improving equity are critical to achieving a high-value, patient-centered healthcare system. But these actions alone will not guarantee that healthcare is affordable for consumers, particularly those who lack insurance or are under-insured. Strategies to improve healthcare affordability include: 

• Achieve Universal Coverage
• Define a State Affordability Standard
• Use, Across Payers, Evidence-based Approaches to Premium Setting and Cost-sharing, Addressing Surprise Medical Bills and Other Consumer-unfriendly Practices
• Rethink Healthcare Subsidies to Improve Fairness
• Implement Regular, Publicly Financed Surveys on Consumer Experience