Educational tool helps residents learn value-based care

The VALUE framework is designed to teach the advantages of weighing costs and quality of care in treatment decisions.

By Carolyne Krupa — Posted Sept. 19, 2012

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Amid increasing emphasis on containing health expenditures while providing high-quality care, a new educational tool is intended to teach medical residents how to evaluate the benefits and cost-effectiveness of treatments for patients.

The VALUE framework is designed to help guide teaching hospitals and residency programs in educating physicians-in-training about providing value-based care. The program is outlined in the September issue of the Journal of General Internal Medicine (link).

“Our model can be used to train young physicians to assess the benefits of medical interventions, with the goal of selecting those that generate high value and reduce unnecessary costs,” said Mitesh Patel, MD, lead author and Robert Wood Johnson clinical scholar at the Perelman School of Medicine at the University of Pennsylvania.

VALUE is an acronym representing the model’s core concepts of validation and variability, affordability and access, long-term benefits and less side effects, utility and usability, and effectiveness and errors. It is the latest educational tool to address the concepts of value-based care.

The American College of Physicians and the Alliance for Academic Internal Medicine announced their High-Value, Cost-Conscious Care Curriculum in Annals of Internal Medicine, published online July 10 (link). The free program is being used by at least 12 internal medicine residency programs around the country. It consists of 10 one-hour, interactive sessions in which residents and faculty discuss the benefits and costs of different treatment options in the context of real patient cases.

Dr. Patel said both programs are effective for clinical training. At Perelman, residents have access to the university’s Center for Evidence-Based Practice, which offers the VALUE framework and other tools for learning about value-based care.

As residents, medical school graduates quickly find themselves immersed in the clinical environment caring for patients. The goal of VALUE is to give residents a tool they can use as they’re seeing patients — whether they’re deciding what tests to order, choosing what medications to prescribe or discussing treatment options, Dr. Patel said.

For example, a resident deciding what medication to prescribe may consider factors such as whether the patient can realistically afford the drug or whether dosage levels are reasonable and can be followed easily.

Student surveys have found that fewer than 50% of medical students feel appropriately trained in topics related to health care policy, such as medical economics and health care systems, Dr. Patel said.

“This deficit in medical school training has been there for more than 15 years,” he said. “The problem is [residents are] making so many decisions quickly that they’re forgetting to consider things like ‘Does the patient have access to insurance?’ ”

The Journal of General Internal Medicine article presents 21 suggestions for ways that educators can incorporate the framework into their training programs. They include discussing the concepts of value-based care in reviewing patient cases with residents, requiring residents to discuss those concepts directly with patients, and mandating that residents attend rounds with social workers in charge of assisting uninsured or underinsured patients.

But integrating such models into residency training comes with challenges, Dr. Patel said. Many medical school faculty members are not trained in value-based care, so educators often are learning at the same time as residents.

“Training residents to practice medicine using concepts of value-based care is like learning a new language for both residents and their teachers,” he said.

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