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How healthcare can learn from Steve Jobs what value means

“Value” may be the single most overused term in healthcare in 2013. It can pretty […]

“Value” may be the single most overused term in healthcare in 2013. It can pretty much mean anything, and everyone wants it.  No one turns down valuable objects or services and so every stakeholder in healthcare is trying to define what value is in healthcare.

Accountable care organizations say value is obtained by slowly replacing fee-for-service with care coordination and fewer unnecessary tests, all while preserving individual choice. The Center for Medicaid and Medicare Services suggests value means improving mortality rates and reducing readmissions by tying hospital reimbursements to nationwide standards. Healthcare.gov suggests value is based on how many services you can get and at what price. It even ranks it for you – bronze, silver, and gold. Every 5th grader knows that gold is the most valuable. In healthcare, however, it may not be.

So, what is value? And value to whom? None of those definitions to me suggests value. To Miriam Webster, it is “the importance, worth, or usefulness of something” and I agree. I have a hunch that the one stakeholder without a voice for what value is, namely patients, would agree as well.

How do I as a patient use mortality rates, readmissions, or the quantity of services offered to gauge value? No one expects to die during surgery and nobody, not even physicians, can tell you what factors exactly lead to a readmission within 30 days? It’s too complex and too abstract.  

For most patients, in contrast, value in healthcare is having a physician (or multiple physicians as part of a care network) who cares about them and relates that to the patient. It is truly that simple. The problem is that it is just very difficult to measure at a consolidated macroeconomic level in which we’re headed. Big Data can never solve this value formula, but small, medium, and growingly large-scale practices already have.

Take, for instance, the idealized small town family practitioner who knows his patients by first name and knows their medical (and social and personal) histories better than his own. Now expand that to a city and add a touch of technology and millennial-focused perks like iPhone appointment scheduling and emailing. That’s a successful OneMedical practice. Now keep expanding that to Kaiser which has grown to be the most popular brand in healthcare through its demand that its doctors engage their patients when not in the office.

All three of these groups – from small to large – understood that patients don’t see metrics. Instead, they see faces, relationships, and community. And they value each to such an extent that they’re willing to pay out-of-pocket, a concierge fee, or the highest on average premiums in the state of California to obtain it. That, inarguably, is healthcare that delivers the best value. It may not be the cheapest or best care based on quality metrics like readmissions, number of Harvard-trained physicians, or US News Ranking, but it is care that patients value.

So, just like an iPhone that costs $699 at Best Buy and can cost upwards of $1100 for a comprehensive data plan over the ensuing year, people buy it, and continue to buy and recommend it largely because Its benefits are tangible – connecting with friends, finding directions, making reservations, “humble-bragging” on your life accomplishments on Facebook. It delivers worth day in and day out.

Healthcare, when it understands the value proposition of an iPhone, can begin to become an industry that is truly focused on creating value because until then, we’ll have a whole lot of talk about value and no real answers that matter to patients. 

Zachary Landman, MD, is the chief medical officer for DoctorBase, a leading developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine and as a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. He is a frequent author and speaker on the topics of patient engagement, mobile health, and patient portals. 


Dr. Zach Landman

Zachary Landman, MD, is the chief medical officer for Doctorbase, a leading developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine and as a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. He is a frequent author and speaker on the topics of patient engagement, mobile health, and patient portals.

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