Could Value-Based Veterinary Care Become the Future Standard of Care?

The concept of One Health evolved from the perception that specialization increases fragmentation and decreases collaboration. We know this to be true across human and veterinary medicine, where specialization has led to compartmentalization and a tendency to work in isolation.¹ This siloed approach to treating patients could lead to negative outcomes, higher costs, and decreased patient and client satisfaction.

Although human and veterinary medicine differ in many ways, similarities do exist. Treatment decisions commonly are triggered by difficult-to-predict health episodes, care is provided by experts who often understand little about the associated costs, and emotional and financial trade-offs are important to the decision-making process.² Furthermore, the pace of technologic advances is similar between the industries, and delivery of care requires lengthy training and occupational licensing.²

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In the United States, 68% of households include a pet.³ In 2017, an estimated $69.4 billion was spent on pets, of which $16.6 billion went toward veterinary care.³ Those expenditures show no signs of slowing down.² Many pets are considered family members,⁴ so clients are likely to seek high-end medical care for them, particularly for serious illness.

In the spirit of One Health, veterinarians and medical doctors can and should learn from each other about better ways to deliver care to their patients, thus improving outcomes and increasing understanding of the costs of that care. For example, veterinarians can learn from their human health counterparts through the strategy of value-based health care (VBHC).

Value-Based Health Care Defined

The cost of health care delivery worldwide has increased to unsustainable levels, now roughly double the rate of gross domestic product growth in most developed countries. Despite the greater spending, however, outcomes vary, and there is no clear causal relationship between money invested and health care delivered.^5,6

The crux of the VBHC strategy is to maximize value—achieving the best patient outcomes at the lowest cost.^5,7 To reach this goal, 1 or more outcomes must be improved without raising costs, or costs must be decreased without sacrificing outcomes.^5,7 By improving value, everyone involved in patient care benefits, and the sustainability of the health care system increases.⁷

With value defined around the patient, VBHC involves shifting to a patient-centered health care system organized around patients’ needs.⁵ Measuring outcomes is a very important part of VBHC. More powerful yet is the concomitant measurement of outcomes and costs for the same clinical condition.

An important principle in structuring any business is to organize around customers and their needs.⁵ In health care, this requires a shift from organizing by specialty department and discrete service to organizing around medical conditions.⁵ Constructing teams—clinical and nonclinical—into integrated practice units (IPUs) allows for collaboration and cooperation as a means of providing better patient care.⁵ One early study of this concept found that heart failure patients had better outcomes when generalists and cardiologists worked together, compared with either providing care alone.⁸

Measuring outcomes is an intricate part of teamwork, as integrated care teams must take joint responsibility for outcomes. The objective of IPUs is to work toward the common goal of maximizing patient outcomes as efficiently as possible.⁵ In this instance, having outcome data is critical for delivering exceptional care.

VBHC is undergoing a transformation. Great advances have been made, but the work continues as the health care system learns from the challenges and opportunities created by its implementation.

What Can Value-Based Veterinary Care Do?

Considering the overall One Health goal of improving health, value-based veterinary care (VBVC) could revolutionize the way we care for animals. Putting patients’ needs first and collaborating among disciplines could unlock a new way of increasing value to our patients and clients.

Similar to VBHC, a VBVC strategy would prioritize delivering outcomes that matter to pet owners in a financially sustainable way.⁹ Outcomes and costs should be measured and interventions toward increasing value implemented.

Veterinary care spending has followed health care spending closely, with 60% more money spent on pet health care in 2012 than in 1996.² Additionally, there is a close correlation between human and pet health spending for end-of-life care, with a distinct spike in spending for both populations.²

The increasing client demand for state-of-the-art veterinary care has resulted in an expansion in referral hospitals with numerous specialty services, creating a multitier care system similar to that in human health care.¹⁰ We veterinarians, however, have more to learn about working together for the better of our patients. Patient referral is often influenced by financial factors, such as the misperception of many primary care practitioners that a referral will lead to lost revenue.¹⁰

A small 2016 study found that dogs with congestive heart failure lived 74% longer when care was provided collaboratively by a specialist and a primary care veterinarian.¹⁰ This study also showed that collaboration actually led to greater revenue for the primary care veterinarian, likely due to the increased survival and need for follow-up.¹⁰ Veterinary Specialists Outreach & Awareness Project, a nonprofit organization for which I serve on the advisory board, is researching the impact of collaboration between specialists and generalists on outcomes and economics. I am hoping this information will soon generate data on the importance of working together in a patient-centered way.

As an adviser, Dr. Pantaleon is involved in many aspects of the veterinary industry, including the study and application of concepts from human health care to improve veterinary patient care. He enjoys advising and educating on infection prevention, participates on several advisory committees, and is on the board of directors for the National Institute of Animal Agriculture.

References:

• One Health: a new professional imperative. American Veterinary Medical Association website. avma.org/KB/Resources/Reports/Documents/onehealth_final.pdf. Published July 15, 2008. Accessed March 9, 2018.
• Einav L, Finkelstein A, Gupta A. Is American pet health care (also) uniquely inefficient? Am Econ Rev. 2017;107(5):491-495. doi: 10.1257/aer.p20171087.
• Pet industry market size & ownership statistics. American Pet Products Association website. americanpetproducts.org/press_industrytrends.asp. Accessed March 9, 2018.
• Understanding the human-animal bond. Human Animal Bond Research Institute website. habri.org/research/. Accessed March 9, 2018.
• Porter ME, Lee TH. The strategy that will fix health care. Harv Bus Rev. 2013;91(10):50-70.
• Larsson S, Tollman P. Health care's value problem and how to fix it. BCG Henderson Institute website. bcg.com/publications/2017/smart-simplicity-health-care-value-problem-how-fix-it.aspx. Published October 23, 2017. Accessed March 9, 2018.
• Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. doi: 10.1056/NEJMp1011024.
• Ahmed A, Allman RM, Kiefe CI, et al. Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care. Am Heart J. 2003;145(6):1086-1093. doi: 10.1016/S0002-8703(02)94778-2.
• Value in healthcare: laying the foundation for health system transformation. World Economic Forum website. www3.weforum.org/docs/WEF_Insight_Report_Value_Healthcare_Laying_Foundation.pdf. Published April 2017. Accessed March 9, 2018.
• Lefbom BK, Peckens NK. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians. JAVMA. 2016;249(1):72-76. doi: 10.2460/javma.249.1.72.