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Transitioning to a High-Value Health Care Model: Academic Accountability

Johnson, Pamela, T., MD; Alvin, Matthew, D., MD, MBA, MS, MA; Ziegelstein, Roy, C., MD

doi: 10.1097/ACM.0000000000002045

Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers’ promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.

P.T. Johnson is director, Appropriate Imaging, physician lead, Johns Hopkins Health System High Value Care Committee, vice chair, Quality and Safety, program director, Radiology Residency, and associate professor, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland.

M.D. Alvin is a second-year diagnostic radiology resident, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland.

R.C. Ziegelstein is vice dean for education, Johns Hopkins University School of Medicine, and professor, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland.

Funding/Support: None reported.

Other disclosures: Drs. Ziegelstein and Johnson are the founders of the High Value Practice Academic Alliance. Dr. Johnson is an unpaid consultant for National Decision Support Company.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Pamela T. Johnson, Department of Radiology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD 21287; telephone: (410) 955-6785; e-mail:

© 2018 by the Association of American Medical Colleges