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The UCSF Center for Healthcare Value
At the helm of the effort to orient UCSF and the rest of the world to a more value-oriented approach to healthcare delivery is the UCSF Center for Healthcare Value (CHV).
Directed by R. Adams Dudley, MD, MBA, the center focuses on research to determine where the areas of low value are in current medical practice, what improves value and what interventions will change the culture. Education is critical to this effort; Sawaya leads the arm of the CHV devoted to training educators, clinicians, researchers and healthcare leaders how to implement high-value, cost-conscious decisions.
The CHV has outlined specific competencies for cost awareness that all healthcare professionals should achieve across all levels of training. It starts with the basics of knowing what cost-effective care is and how to discuss cost and value-based decisions with colleagues and spans all the way to understanding cost-sensitive policy decisions on a national scale.
To help enable physicians to practice high value care and convey these skills to learners, the CHV has funded three “Teaching to Choose Wisely” awards at $20,000 each. These projects, one of which positions medical students as “high-value care officers,” have tangible elements that can be incorporated into the curriculum to be used not only at UCSF, but also shared across the country, says Sawaya.
What is Value-Based Healthcare?
Some examples of value-based decision-making in the clinic include:
1. Biennial screening women for breast cancer instead of annual or starting at age 50 rather than at 40. All of the schedules show some benefits in terms of breast cancer mortality, but a strategy to maximize benefit and minimize harm might be to screen less frequently and in a more focused way.
2. Ordering imaging, such as CT and MRI scans, for a patient complaining of a headache. Imaging may often be ordered as a response to the legal implications of missing a rare diagnosis of brain tumor. Value-based healthcare advocates focus on how to ensure early diagnosis of the majority of brain tumors without unwarranted costly imaging.
3. Drawing blood from hospital patients repeatedly. Excessive inpatient laboratory testing leads to unnecessary health care costs and exposes patients to harms that could be avoided. “Think Twice, Stick Once” is an ongoing UCSF Medical Center campaign to reduce blood draws that emphasizes the importance of patient experience while seeking to provide high-value care and avoid patient harm.