Recently, I was on a panel addressing healthcare trends, and was asked to describe the current push for healthcare to move from volume to value. A fairly mundane, typical topic that I have addressed multiple times. But, this time I found myself feeling, and then telling a somewhat chagrined moderator, that this struck me as a silly question and that the phrase, ‘volume to value’, has been worn out and has lost its meaning. I probably won’t get invited back to that meeting, but it made me start to wonder: what does it mean and why do we keep using that phrase?
Don’t get me wrong, I have been in this dialogue long enough to understand the proposed purpose of the phrase and its reference to a more enlightened approach to paying providers. I understand that this is how we ‘save healthcare’ and achieve the ‘triple or quadruple aim.’ I understand that it refers to ACO’s in all their varieties and bundled payments and even to ‘value based purchasing.’ I know that we believe that the existing incentives are off and that by changing the incentives built into the payment of health care we can improve the health of our population.
Granted, the phrase has a ring to it, and on the face of it sounds directionally correct. I mean who wouldn’t want to report to their board or the public that we are on this noble journey from a system with seeming nefarious intent to one based on high ideals. Certainly, we have to have a strategic plan, and if everyone agrees that the path to virtue leads away from volume and towards value, then all we need to do is to convince our stakeholders that we know how to navigate that path better and faster than everyone else.
And, true confessions, I have been guilty of using this time worn phrase “from volume to value” more than I care to admit. And as I look back, it may have had some use at some point to jump start a way of thinking or to stimulate some debate.
But, now, all I see is a phrase so over used that it is devoid of meaning. It has become a catch all for anything that seems ‘transformational’ (another misused/overused term—but we will save that for another day).
Look, I know this is heresy. Almost every healthcare CEO I know is singing from the same song sheet on this one. And they are backed up by an army of consultants selling them advice on how they can get there faster than their competitors.
It is just that it represents an unhelpful indictment of the current system and presents a false dichotomy that hinders progress.
Further, it lacks integrity and is used as a matter of habit and without clear intent of meaning. At times, it is used pejoratively to deride providers who are assumed to be after financial returns that accrue from volume, while implying that they have deliberately or unknowingly underperformed on value. At other times, it is merely used quixotically to aspire to some undefined and ambiguous ideal future state. As a result, it has become a distraction and I believe we need to move on to more productive language.
Image Credit: Mark Froimson/LinkedIn