With the growth in risk-based and accountable care organization contracts, creating value by redesigning care to reduce costs and improve outcomes and the patient experience has become an urgent priority for health care systems.
In 2016, UCLA (University of California, Los Angeles) Health implemented a system-wide population health approach to identify patient populations with high expenses and promote proactive, value-based care. The authors created the Patient Health Value framework to guide value creation: (1) identify patient populations with high expenses and reasons for spending, (2) create design teams to understand the patient story, (3) create custom analytics and spending-based risk stratification, and (4) develop care pathways based on spending risk tiers. Primary care patients with three chronic conditions—dementia, chronic kidney disease (CKD), and cancer—were identified as high-cost subpopulations.
For each patient subpopulation, a multispecialty, multidisciplinary design team identified reasons for spending and created care pathways to meet patient needs according to spending risk. Larger, lower-risk cohorts received necessary but less intensive interventions, while smaller, higher-risk cohorts received more intensive interventions. Preliminary analyses showed a 1% monthly decrease in inpatient bed day utilization among dementia patients (incident rate ratio [IRR] 0.99, P < .03) and a 2% monthly decrease in hospitalizations (IRR 0.98, P < .001) among CKD patients.
Use of the Patient Health Value framework is expanding across other high-cost subpopulations with chronic conditions. UCLA Health is using the framework to organize care across specialties, build capacity, and grow a culture for value.
R. Gupta is interim chief value director, UCLA–Olive View Medical Center, former medical director of quality improvement, UCLA Health, and assistant professor, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California.
L. Roh is director for population health, UCLA Health, University of California, Los Angeles, Los Angeles, California.
C. Lee is a program manager for population health, UCLA Health, University of California, Los Angeles, Los Angeles, California.
D. Reuben is director, Multicampus Program in Geriatrics Medicine and Gerontology, chief, Division of Geriatrics, professor of medicine, and director, UCLA Claude D. Pepper Older Americans Independence Center and Alzheimer’s and Dementia Care Program, University of California, Los Angeles, Los Angeles, California.
A. Naeim is associate director, Clinical Translational Science Institute, and chief medical officer, Clinical Research, UCLA Campus and Health System, and professor of medicine, Divisions of Hematology–Oncology and Geriatric Medicine, University of California, Los Angeles, Los Angeles, California.
J. Wilson is director, Kidney Health Program, Kidney Stone Center and Surgical Consultative Nephrology, UCLA Health, and associate professor, Division of Nephrology, University of California, Los Angeles, Los Angeles, California.
S.A. Skootsky is chief medical officer, Faculty Practice Group and Office of Population Health and Accountable Care, UCLA Health, and professor of medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California.
Funding/Support: Faculty and staff time on this program were supported under the operating budget of UCLA Health.
Other disclosures: R. Gupta is the director of evaluation and outreach at Costs of Care, Inc.
Ethical approval: Reported as not applicable.
Correspondence should be addressed to Reshma Gupta, Quality Improvement, UCLA Health, 10945 Le Conte Ave., Suite 1401, Los Angeles, CA 90095; telephone: (310) 206-8987; email: R44gupta@ucla.edu.