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Over recent years, hospitals have increasingly focused on improving value: outcomes achieved per dollar spent.1 Although prior efforts to address costs and overuse in healthcare date back decades,2 the modern movement in hospitals has largely progressed through overlapping stages, focused first on raising awareness and articulating the motivation for addressing costs and healthcare waste in education and care delivery.3–9 Some hospital leaders began exploring the effect of simply providing cost transparency to clinicians, with limited results.10 11 In concert with the launch of the ‘Choosing Wisely’ campaign in the USA in 2012, hospitalists led projects that largely sought to root out individual areas of overuse and ‘things we do for no reason’, ushering in a renewed emphasis on utilisation in hospitals.12 13 Now, we have begun to see results from health systems that have created organisational value improvement programmes for hospitalised patients to simultaneously address both utilisation and costs, while measuring markers of quality and ensuring favourable patient outcomes.14–16
In this issue of BMJ Quality & Safety, Horwitz and colleagues16 describe the impact of a large-scale, hospital value-based management (VBM) programme at New York University Langone Medical Center (NYU). The institution-wide programme began in April 2014 with significant investment in creating joint clinical and operational leadership, data and cost accounting capabilities, a centralised project support staff, and a shared savings programme. The model focused primarily on projects led by clinicians (with a project manager co-lead) to decrease costs across six main domains: operational efficiency, resource utilisation, supply chain management, revenue cycle, outliers (highest cost patients) and corporate services (administrative and overhead costs). Over the first 3 years of the programme, they chartered 74 total projects, and saw a significant 7.7% decrease in adjusted variable costs, without measured changes in markers of quality …
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