About High-Value Care Culture

High-value care = Outcomes / Total Costs of Care

The pressure on delivery systems to provide high-value care has been increasing in the US due to the growth of value-based purchased payment models, consumer awareness, and payment reform measures like the Value-Based Purchasing (VBP) Program of 2012 and The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015.

Despite these changes and pressures, health systems often lack tools to identify target areas for improvement and to engage clinicians in the cultural changes needed for a shift to value-based practices.

Definitions used in the High-Value Care Culture Survey

The HVCCS uses definitions adapted from the National Academy of Medicine (formerly the Institute of Medicine)

High-value care: Care that maximizes quality while minimizing costs

Quality: The degree to which health services increase the likelihood of desired health outcomes that are safe, effective, patient-centered, timely, and equitable and are consistent with current professional knowledge

Cost: The negative financial, physical, and emotional effects to patients and the health system

The Importance of Organizational Culture

“The writer David Foster Wallace once told a parable about two young fish who meet an older fish who nods at them, and says, “Morning boys, how’s the water?” The two young fish swim on, and then eventually one of them looks over at the other and asks, “What the hell is water?” Sometimes the most obvious, important realities are the most challenging to talk about.

Organizational culture, like the water surrounding fish, is all around us, yet can be difficult to perceive from within. This culture or “imprinting”—defined as a system of shared assumptions, values, beliefs, and norms existing within an environment—creates a powerful undercurrent that shapes the practices of all health care providers and contributes to overuse within the health care system. Recent work to improve health care value focuses on creating guidelines and algorithms, such as Choosing Wisely lists and appropriateness criteria. While it is important to codify best practices, we must recognize that, even with such guidelines in place, we are largely still swimming in the same cultural “water.”” (Read the full article: “Swimming Upstream: Creating a Culture of High-Value Care”)

In the field of patient safety, validated surveys of organizational safety culture have been useful in identifying opportunities for improvement and motivating change. In fact, higher patient safety scores are associated with changes in clinician behaviors and to improved safety outcomes on hospital wards and across entire health systems.

Read more about patient safety culture at AHRQ Patient Safety Network.