Four Domains of a High-Value Care Culture

HVCCS Domains: Leadership and health system messaging, Data access and transparency, Comfort with cost conversations, Blame-free environment

Leadership and health system messaging

This first factor consists of 17 questions and covers engagement with frontline clinicians, leadership visibility and support, high quality communication about quality and safety of care, role modeling, and pride and formal training in value-based care.

Data transparency and access

This second factor focuses on the availability of cost data for frontline clinicians. This factor consists of two questions.

Comfort with cost conversations

A total of three questions make up this third factor. This factor covers comfort of clinicians to have conversations about costs with patients.

Blame-free environment

The fourth domain is comprised of two questions and focuses on a sense of individual blame within divisions, practice groups and training programs.

Initial Validation Results Between Two Large Academic Medical Centers
(see full article here)

Domains Sample Questions (Agree to Disagree Scale) Domains, Scores 0-100, 100=best P-value VBP Score Correlation (r)
Center A Mean(SD) Center B Mean(SD)
Leadership & health system messaging (alpha 0.9) “The majority of clinicians in my group consistently role model providing quality care a lower cost…”

“The leadership in our group value efforts to deliver quality care at lower cost…”

57.5 (14.0) 76.0 (12.2) <0.0001 0.57
Data transparency and access (alpha 0.8) “Clinicians in my group have access to information about the costs of tests and procedures they order or provide…”

“When clinicians in my group have questions about costs, they know where to go to find answers…”

31.0 (20.1) 37.9 (26.2) <0.0001 0.15
Comfort with cost conversations
(alpha 0.7)
“Clinicians in my group are uncomfortable discussing costs of tests or treatments with patients…”

“Clinicians in my group feel that it is not the role of physicians to discuss costs of tests or treatments with patients…”

54.9 (19.4) 53.5 (18.5) 0.605 0.04
Blame-free environment (alpha 0.7) “Individual clinicians get blamed for medical or surgical complications…”

“In my group, clinicians' fear of legal repercussions affects how often they order unneeded tests or procedures…”

46.0 (23.3) 63.4 (19.4) <0.0001 0.37
Overall HVCC score 47.3 (12.8) 57.7 (11.5) <0.0001 0.39