Soraya Ghebleh - Variation in Healthcare Delivery

Soraya Ghebleh

UNWARRANTED VARIATION IN HEALTHCARE DELIVERY

Unwarranted variation refers to differences in the practice of

medicine that cannot be explained by illness, medical

need, or evidence-based medicine.

DEFINITION

¡ Effective Care ¡ Preference-Sensitive Care ¡ Supply-Sensitive Care

THREE MAIN CAUSES

Interventions for which benefits far outweigh the risks and the right rate of treatment is for every patient that meets

clinical guidelines to be in need.

EFFECTIVE CARE

When given two equally viable treatment options, the patient must make a decision about

their treatment and the correct rate of use should depend on

patient choice.

PREFERENCE-SENSITIVE CARE

Refers to capacity determining the amount of treatment a

patient receives rather than whether the treatment is

necessary for a better patient outcome.

SUPPLY-SENSITIVE CARE

Regions with higher use DO NOT

demonstrate better outcomes overall.

Unwarranted variation is one of the drivers of excessive waste in the

healthcare system.

It contributes to wide differences in the quality of

care and disparities in health outcomes across

clinical settings.

¡ Shared-decision making ¡ Re-aligning financial incentives with

value-based care ¡ Improving health outcomes research

and disseminating information accordingly to providers

STRATEGIES TO REDUCE UNWARRANTED VARIATION

¡ Addresses preference-sensitive care by providing the means for patients to understand the implications of decisions about healthcare

¡ Increases patient education ¡  Involves the patient in the decision ¡ Helps patients ask the right questions

about how to proceed with care

SHARED-DECISION MAKING

¡ Under fee-for-service model of reimbursement, physicians are rewarded for volume-based care

¡ Key driver in supply-sensitive care ¡ Introduce new payment models that can reduce

utilization and provide and reward care based on value and need rather than quantity

¡ Shift from the “more is necessarily better” attitude in healthcare delivery

RE-ALIGNING FINANCIAL INCENTIVES

¡ Many providers are unaware that their outcomes differ from other providers, even within their own institutions

¡ Development of strong, evidence-based outcomes data is essential in determining what is effective and necessary care

¡ Creation of national registries ¡ Sharing more data ¡ Partner with providers to create more transparency in

outcomes

HEALTH OUTCOMES RESEARCH

¡  This information is based on research done by Dr. Jack Wennberg and colleagues at The Dartmouth Institute for Health Policy and Clinical Practice

¡  Read More: §  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124450/ §  http://www.dartmouth-hitchcock.org/dhmc-internet-upload/

file_collection/Wennberg%20JE%20-%20Practice%20Variations.pdf

SOURCE