Value-Based Medicine

NEW COLUMN!
VBM: A Timely Yardstick for Effective Care

By Melissa M. Brown, MD, MN, MBA

Value-Based Medicine… sounds important… sounds right… sounds like we should know what that means.

Correct on all accounts. Value-Based Medicine (VBM) has been around a long time but we are only relatively recently hearing all about it. It is the practice of medicine based upon value conferred by medical interventions. Sounds simple, but one would rightly wonder if the devil is in the details. (yes, but is very manageable). How is value defined? Improvement in quality-of-life and length of life. That one is easy but many other questions arise.

What's Special About VBM?

It is the who's, what's, where's, when's and why's that will be the topic of this new column in Ophthalmology Management. The framework of VBM will be teased apart and elucidated. We will see that VBM can be the foundation for an important information system for patients and their physicians to identify the highest quality-of-care available. We will see how evidence-based medicine can provide numerical and statistical information. We can look at how one evaluates the clinical studies to be valid, sources of error and their effects on the data. We will look at how these analyses affect our clinical decisions in ophthalmology and beyond. And we will see the data that show what we have long understood: that our ophthalmic interventions are of great value to our patients!

I will clarify how this information needs to be taken to a higher level, which ascertains the true value of evidence-based discoveries to our patients. Incorporating the quality-of-life effects of adverse events along with efficacy gives much of the information needed to assess patient value.

Measuring Quality of Life

We will examine the best ways to measure the quality-of-life changes and the best ways to critique the methodology. We will learn what the ideal QOL instrument is and what type of instrument can fit the bill to adequately assess changes. Terms such as utilities, quality-adjusted life years (QALY), total QALY gain, decision analysis, markoff modeling and discounting will become real and clinically relevant. Hard to believe — but true!

The differences among functionally based (NEI-VFQ 25) and performance-based (utility analysis, standard gamble) quality-of-life methodologies will be highlighted as well as their application to assessing value of medical interventions including pharmaceuticals.

Once analyses of value are accomplished, we will begin to focus on interventions of similar value, as most physicians strive to provide the best quality of care and that with the highest value. Once a group of interventions of similar value are identified, a systematic, standardized approach to amalgamating costs can help identify the most cost-effective treatments. We can then, and only then, identify cost-saving care without sacrificing any quality of care.

The Impact of Costs

A discussion of the application of costs will become clearly relevant. Direct medical costs, indirect medical costs, and direct non-medical costs can be described. And I will try to elucidate why high quality medicine actually contributes a huge return-on-investment to society rather than just being considered a drain on our financial resources. We not only can help improve our patients quality-of-life but we can improve the bottom line to society as well.

Now if this doesn't sound fun, I will ask you to give me a little slack here. I have been working with evidence-based and value-based concepts for a decade. It can sometimes get tedious when I lose sense of why I am doing it — something like missing the forest by counting every tree. But contributing to maintaining a comprehensive healthcare system for our children is good for starters, and identifying the highest quality of care isn't bad for an encore.

I earnestly believe that physicians must not only be aware of the components of VBM but be able to translate the information into excellent clinical care and be part of the political process to assure that our educated and professional voices be heard in support of the very folks we treat everyday — our patients. I very much look forward to sharing these concepts and beliefs with you over the upcoming months. OM

“Value-Based Medicine” is a registered trademark of the Center for Value-Based Medicine.

Melissa M. Brown, MD, MN, MBA, is president and CEO of the Center for Value-Based Medicine in Philadelphia. She can be reached via e-mail at mbrown@valuebasedmedicine.com.