Given the known unsustainable growth in medical expenditures, the health care market is moving away from a volume-based paradigm to value-based payments (Value= Quality + Service/Cost). While the definitions of quality and service (satisfaction) are being refined, the cost portion of the equation has been challenged by a lack of transparency as well as provider/patient disengagement. More specifically, the stakeholders making the actual care delivery decisions are disconnected from the cost of those decisions at the time they are being made. Physicians have generally not been aware of or been directly affected by their day to day decisions in managing their patients and the related direct and/or indirect associated costs. Furthermore, until recently, patients had relatively small out of pocket copayments with little if any incentive to request equally effective but less costly treatment from their physicians. This situation creates significant unnecessary barriers to cost control and delivering value-based care.
We believe that real-time cost information provided to physicians and patients during episodes of care will spur a cultural transformation. While uncomfortable and perhaps disruptive, the information will force physicians to recognize and understand the expenses associated with each and every step-order they generate on behalf of any of their patients. At the same time, the patient receiving the care will have immediate access, via MyChart, to the projected out of pocket cost data to inform participation in the discussion and decision-making process. The providers, at the time of posting a case, will receive an InBasket message alerting them to their historical cost for that procedure relative to their peers.