Quality is the Key to Healthcare Value

By Brian Klepper PhD | Published 9/22/2018 2

Quality word on white puzzle 1500 x 997

Both cost and quality must be optimized to achieve meaningful healthcare value (Photo source: Adobe Stock)

At its core, America’s healthcare value crisis is rooted in our system-wide failure to focus on managing quality. Health outcomes for specific conditions and procedures vary wildly across providers, health plans, and markets. A highly regarded 2008 PricewaterhouseCoopers study estimated that more than half of US healthcare spending provides no value.

Our health system optimizes revenues, no matter what

Our health system optimizes revenues, in part, through excessive care. This means that many clinicians largely disregard quality. And, they ignore whether treatment pathways are right or founded in evidence. If you compare U.S. care patterns to those in other developed countries – or to the top-performing domestic programs – overtreatment is obvious.

Putting medical errors aside, vast quantities of care are intentionally unnecessary. This is a problem so pervasive that, compared to other developed nations, we’ve come to consider our inflated procedural statistics as normal.

Half or more of all orthopedic surgeries are inappropriate. We administer chemotherapy regimens to cancer patients that often lack proven efficacy. According to an article in JAMA Internal Medicine,

“Our results show that most cancer drug approvals [by the FDA] have not been shown to, or do not, improve clinically relevant endpoints.”

Even after an abundance of evidence showing that coronary stents provide no significant benefit in stable heart patients, we implant thousands every day. And on and on and on.

We must follow the evidence

When care follows the evidence, health outcomes and improvements in cost can be dramatic. This is clear in the emerging crop of “high performance” healthcare organizations that consistently deliver better health outcomes and/or lower costs than conventional approaches.

Typically, these firms’ founders are data- and evidence-driven, passionate, and mission-driven. They also have high subject matter expertise in whatever niche they work. And, they have deconstructed a problem in that space and devised, then refined, solutions that are, in most cases, different than the conventional approach.

Because these types of founders are typically so confident about their ability to perform that they are often willing to guarantee their results. In other words, they put their fees at risk against the performance targets they claim they can achieve.

Integrated Musculoskeletal Care

A striking example is Integrated Musculoskeletal Care (IMC), a Florida company that generates breathtaking results. Two senior clinicians lead the organization. Both began as practitioners of Mechanical Diagnosis and Therapy (MDT).

MDT a credible medical discipline that is especially valued for the precision of its diagnostic approach. MDT has a reliable assessment model that allows clinicians to accurately isolate and identify the source of pain. In most cases, the model allows them to classify or select the most appropriate care for musculoskeletal patients.

Academic studies have demonstrated MDT’s efficacy. However, like nearly all of modern medicine, little or no quality management infrastructure has been in place to reveal in real-time whether each intervention benefited, harmed, or had no material impact on the patient.

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Building a better mousetrap to achieve healthcare value

In response, the IMC team set about building its own quality management system. They adopted validated indices capable of measuring a patient’s perceived pain, function, and disability as a gold standard metric to measure clinical effectiveness. Every time they intervened with a patient, they recorded and watched the numbers. In most cases, patients responded positively.

When a pattern emerged that showed a less-than-desirable result, they rethought their model and course-corrected the treatment pathway. They also updated their protocols. And, they did this over and over and over again.

Over time, with repeated adjustments, their clinical model organically evolved. It was no longer MDT, but a different fully fleshed out musculoskeletal disorder treatment methodology.

The results have been compelling

The results, developed over several hundred thousand patient encounters, have been compelling. Clinicians using IMC’s approach can appropriately intervene in 90 percent of musculoskeletal disorder cases.

Compared with conventional treatment:

  • pain drops dramatically
  • function with daily activities improves
  • suffering duration goes down by half
  • surgeries are reduced by two-thirds
  • imaging studies are cut in half
  • injections are reduced by two-thirds

Further, the likelihood that a patient will have recurring, intensifying problems every year or so drops by 60 percent. Importantly, the cost typically goes down by half. This is a result so strong that the company financially guarantees a 25 percent reduction in musculoskeletal spending on the patients they care for.

An achievement of staggering proportions

Now consider this. This performance occurs in an area that consumes about 20-25 percent of all group health spending, and 60 percent of occupational health.

It’s typically the most prevalent problem and the top spending category in any health system. IMC’s approach is essentially a better mousetrap. It consistently delivers better health outcomes in about half the time and half the cost.

The fact that IMC has found a better way is overwhelmingly impressive. They got there, in large measure, by the development of an approach that lets them, in real-time, watch their own results and course-correct as appropriate. This is an achievement of staggering proportions.

Why isn’t everybody doing it?

IMC’s success begs an even bigger question about this perfectly logical but exceedingly rare effort. It makes you wonder why aren’t clinicians within every medical domain (cardiology, ophthalmology, gynecology, endocrinology, urology, neurology) following the same path?

Isn’t there every reason to replicate their approach, clinical monitoring, and improvement? Particularly since it represents a combination of Deming and the scientific method. Shouldn’t that accelerate clinical effectiveness? And, shouldn’t that make quality the most important vector in medicine? Further, isn’t it likely that that would make care far more efficient as well?

The bottom line when it comes to healthcare value

The quality we all claim to seek in American health care is sitting in pockets right in front of us. We only have to plant it in every medical domain and watch health care’s beautiful flower bloom.

Brian Klepper PhD

Website: http://www.worksitehealthadvisors.com/

Brian Klepper is the Executive Analyst and Editor at the Health Value Institute. He is also a Principal at Worksite Health Advisors which advises purchasers seeking higher value health care and vendors seeking to deliver high performance. He speaks and writes extensively on clinics, high-performance health care and the management of clinical and financial risk.


  • These new approaches are not new and are what we should have been doing all along. I feel great concerns when I look at how mental health care is practiced. The biggest thing missing is the will to do it well. Also the lack of curiosity among some therapists and doctors is frightening. Treating people should be a passion.

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