As discussed previously, the Perioperative Surgical Home (PSH) model has vast potential to disrupt the standards of anesthesia care. In a follow-up to that discussion, proposals in the anesthesiology community are now suggesting a value-based strategy to address efficiency and patient satisfaction in the surgical setting. In this strategy, a complex value analysis will be undertaken in symphony with the PSH model, allowing for a successful patient care episode. In-depth analyses of value across the patient journey, particularly utilizing a collaborative approach, are necessary to further develop high-quality anesthesia management.
To effectively implement a value-based approach to anesthesia care, it is necessary to introduce the concept of a “value chain”. This concept was widely discussed at the recent American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference. The consensus was that from pre-surgery to post-operative recovery, each step on the value chain should add value in a meaningful and significant way. Experts proposed the value chain as a viable means of quantifying a clinical pathway with respect to value. To evaluate value added at each stage of the chain, healthcare administrators can utilize measures such as cost offsets and improved clinical outcomes. Both of these factors largely impact the quality of care the hospital provides as well as the resources the institution can allocate to support such care. Once a thorough analysis of such variables is measured at each stage of the chain, steps which are not additive may be placed under consideration for removal. It is important to note that anesthesia clinicians such as physicians and Certified Registered Nurse Anesthetists (CRNAs) are highly important to the concept of the value chain. If an anesthesiologist and/or CRNA can support preemptive management of the patient’s recovery post-surgery, employing such tools as glucose management and infection prevention, then it is far less likely the patient suffers worse clinical outcomes post-surgery.
Anesthesiologists, CRNAs, and healthcare administrators each have unique roles to contribute in this aim. One concrete way in which all three can support a value-based approach to anesthesia care is in product selection. Traditionally, healthcare administrators engage in contracting discussions with supply manufacturers without the input of clinicians. However, a value-driven approach to patient management recognizes that clinicians often have the highest level of direct experience in product utilization and thus their opinion is essential to finding an appropriate solution. For example, anesthesiologists and CRNAs can provide real world experience of the tools, products, and medications that they utilize on a daily basis. By engaging anesthesiologists and CRNAs throughout the decision-making process, healthcare administrators can ensure that contracting with manufacturers reflects the actual practice needs of clinicians. Furthermore, once equipped with real world utilization data, healthcare administrators may have capacity to advocate for value-based contracting directly with manufacturers. Value-based contracting is a contracting approach in which the hospital’s compensation to the manufacturer is dependent on the performance, utilization, and/or outcomes of the product in a surgical setting. Such tools are highly effective in promoting value across clinical specialties and patient populations alike.
To conclude, value is increasingly important in the development of anesthesia management. Anesthesiologists and CRNAs are well positioned to work alongside healthcare administrators in order to define a clinical pathway that ensures value at each step of the way, resulting in the highest standard of clinical excellence on an institutional level.