“Value” is a word that has long aroused skepticism among physicians, who suspect it of being code for “cost reduction.” Nevertheless, an increasing number of health care delivery organizations, including my own, now describe enhancement of value for patients as a fundamental goal and are using concepts developed by Michael Porter (see 10.1056/NEJMp1011024, and the framework papers in Supplementary Appendixes 1 and 2 of that article) to shape their strategies. What has changed? And what are these organizations actually doing?
Practical motivations lie behind the interest in the value framework. Rising costs and a stagnant economy pose problems with no easy solution. Budgets cannot be planned responsibly by hoping for growth in volume. As all players try to protect their incomes, nerves are fraying. Physicians are pitted against hospitals, specialists against primary care physicians, academics against the community.
In this fractious context, value is emerging as a concept — perhaps the only concept — that all stakeholders in health care embrace.
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