Implementing anti-waste policies requires conversations on value

As we prepare for the 2018 Lown Conference on April 9-10, we want to help you get ready as well. So we’re putting out interviews with some of our keynote speakers and panelists so you learn more about what to expect at the conference, and start getting excited!

Register for the conference and view our full program of speakers and panels on our website

We know overuse is rampant in our health care system. But facing the problem of low-value care takes more than just restricting certain drugs and procedures. As governing bodies and societies make policy changes, they need to be considerate of people’s experience of the health care system, and thoughtful in their own work. Part of this means engaging both clinicians and patients in a conversation about what value means when it comes to health care.

In their breakout panel, “Who decides what value means?”Dr. Susan Perez, Assistant Professor at California State University – Sacramento and Leif Wellington Haase, leading author and researcher on the US health system, will discuss what happens when patients are engaged – or excluded from – conversations around value. 

Haase’s research explores one of the most important health care initiatives aimed at reducing low-value care, the Oregon Health Plan. This broad plan was designed to reduce waste and save money by evaluating which tests and procedures weren’t worth paying for, and halting reimbursements for those deemed low-value. One of the unfortunate flaws in the plan was that there was no talking to patients about what the plan would mean for them and why they were doing it. 

“The worry was if they had made it more public, the law might not have gotten passed. But not talking about the plan caused more problems during implementation,” said Haase.

Dr. Perez’s research dives into how patients and doctors have conversations about value. In focus group research Perez found that patients and doctors both want to have conversations about how much care will cost and low-cost alternatives. But doctors do not have a lot of tools to navigate these conversations, and even patients who take charge of their own health may not feel comfortable talking about their financial security. Patients may also feel powerless to reduce the burden of health costs, even if they were to talk about it. 

We asked a patient, how could you reduce your health care cost?” said Perez, “He said, ‘I could die.'”

Perez finds that getting a conversation started is often the most difficult part. “Patients are waiting for permission to have these conversations and ask these questions,” she says. At the panel, Perez will discuss the next step in her research – developing messages for patients that will help them start cost conversations with doctors.