It has been estimated that 20-30 percent of expenditures dedicated to health care employ either over-, under-, or misutilization of medical treatments and technologies, relative to the evidence of their effectiveness (Skinner et al., 2005). Despite 60 percent more frequent physician visits, testing, procedures, and use of specialists and hospitals in high-spending areas in the United States, no differences in quality result (Fisher et al., 2003). Perhaps up to two-thirds of spending increases in recent years have been due to the emergence of new medical technologies that may yield marginal enhancement of outcome or may benefit only a small number of patients (Cutler, 1995; Newhouse, 1992; Smith et al., 2000). All of these findings raise basic questions about the orientation and incentives of healthcare training, financing, and delivery.
A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. These approaches, ranging from value-based payment design to improved systems of care delivery, have garnered growing attention in the midst of the national and international economic crisis. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated system-wide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress (Leavitt, 2008; Paulus et al., 2008).
To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care convened a workshop entitled “Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation” in November 2008 at the National Academies in Washington, DC. This workshop was part of the Learning Healthcare System workshop series and aimed to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. In this context, the IOM provided a forum for the discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers, and outlining the opportunities for next steps. The first day of the workshop focused on illuminating stakeholder perspectives on health care and describing approaches to defining and measuring value. The second day highlighted a number of different approaches to obtaining value in both the present and the future. The workshop agenda is provided in Appendix A,