What Does Value Based Medicine Mean to You and Multiple Sclerosis?

Value based medicine has become a recurring theme of health care reform for the past 5 years. The reasons are quite simple. In all developed countries, spending on health care increases in direct proportion to GDP but improvements in health outcomes tend to plateau as spending on health care exceeds 10% of GDP. Think about this as our health care expenditures approach 18% of GDP in the United States; if this statement is true then approximately 1.2 trillion dollars in health care spending per year is not achieving desired outcomes or at worst is wasteful, unnecessary or fraudulent.

So we return to the question, how do we define value in medicine? The corollary to this statement is, when does a procedure or treatment or other billable medical act warrant the costs of that act? Costs in the scenario could be defined as dollar costs, costs from adverse effects or lost quality of life for some interval of time. For decades doctors have argued that patients did not have the training or information to determine quality and value in medicine. This paternalistic and condescending approach to decision making in medicine will continue to fall apart as long as you, the patients, remained engaged in the process. There are many things that can be said about President Obama, but his Affordable Care and Portability Act did create a new agency called the Patient Centered Outcome Research Institute (PCORI) that is tasked with involving patients in the process of determining value in medicine.

So it is time for all of you to think about what it means to achieve value in your MS care; you’ve lived it and know the good and the bad of what we have to offer. So let’s hear your thoughts on this topic. What is of value to you in your current care and what would be of greater value to you that is not currently available.  Let me give you some ideas to respond to in your replies:

Do you value luxurious medical office suites or are the basics okay with certain features like friendly knowledgeable staff and WiFi while you wait?

Do you value being able to see or contact your doctor or health care provider when you have a problem or concern?

Do you value a doctor who takes the time to explain things to you?

What is the minimally acceptable time for an appt with your MS doctor ? 10, 20, 30, 40 minutes?

Do you value transparency in insurance coverage prior to signing up? For instance, are you able to find out if an insurance plan covers MRI scans or all the treatments you may be interested in receiving before you sign up for the plan?

Would you not value the development of a blood test that could predict your likelihood of responding to a treatment?

Would you value greater practical advice from your doctors and health care providers on services they often do not  learn enough about in the course of their training such as basics in ambulatory aids, wheelchair seating, diet, exercise and complementary and alternative care?

Do you value preventing relapses or preventing disability? Or is your overall goal maintaining or improving quality of life?

Do you value the health care journey website where you can go for free to get expert advice and answers to important MS related questions? What would increase the value of the site for you.

Just some things for you all to think about as we try to improve the value of medicine through this web site.

-Dr. Kinkel