Delivery of High Value Medical Care

Purpose and Rationale for the Course: As medical students continue to gain knowledge and skills to best diagnose and treat patients, it will be imperative to maintain the principles of high value care to balance cost conscious evidence based care with patient centered care. This course will explore the essential concepts of high value care, low value care, avoiding harm and engagement strategies with colleagues and patients to improve patient outcomes.

Course Learning Objectives:

By the end of this course, the student should be able to:

1. Describe the principles of value-based health care.
2. Demonstrate shared decision making with patients and families.
3. Demonstrate interprofessional  communication to limit low value care and promote patient-centered care.

Course Description: This course will utilize the “Discovering Value-Based Health Care” learning modules created by Dell Medical School to explore content on high value care.

WEEK 1:

1. Pre-Reading 1.5 hours
   
   1. Berwick DM, Hackbarth AD. Eliminating Waste in US Health Care. JAMA. 2012;307(14):1513–1516. doi:10.1001/jama.2012.362
   2. Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978
   3. Owens, D. K. (2011). High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. Annals of Internal Medicine, 154(3), 174. doi: 10.7326/0003-4819-154-3-201102010-00007
   4. Pasik, S., Korenstein, D., Israilov, S., & Cho, H. J. (2018). Engagement in Eliminating Overuse. Journal of Patient Safety, 1. doi: 10.1097/pts.0000000000000487
2. Dell Module Collection 1 (Introduction to Value-Based Care) and Dell Module Collection 2 (Value-Based Health Care Delivery) 5.5 hours
   
   1. Complete Self-paced online Modules 1-5
3. Group Discussion at end of week 1 2 hours
   
   1. Students will share at least 1 impression from readings or modules at start of session and 1 take-away from session at end
   2. A facilitated group discussion with students presenting and leading discussions on their assigned module (individual or group) either using their own questions from materials or personal experiences

WEEK 2:

1. Pre-Reading 1.5 hours
   
   1. Rifkin E, Lazris A. A Grateful but Not Passive Patient. JAMA Intern Med. 2016;176(9):1248–1249. doi:10.1001/jamainternmed.2016.3569
   2. Lowenstein M. Choosing Our Words Wisely. JAMA Intern Med. 2016;176(9):1249–1250. doi:10.1001/jamainternmed.2016.3653
   3. Ganguli, I., Simpkin, A. L., Lupo, C., Weissman, A., Mainor, A. J., Orav, E. J., … Sequist, T. D. (2019). Cascades of Care After Incidental Findings in a US National Survey of Physicians. JAMA Network Open, 2(10). doi: 10.1001/jamanetworkopen.2019.13325
   4. Patel, M. S., Davis, M. M., & Lypson, M. L. (2012). The VALUE Framework: Training Residents to Provide Value-Based Care for their Patients. Journal of General Internal Medicine, 27(9), 1210–1214. doi: 10.1007/s11606-012-2076-7
2. Dell Module Collection 3 (Improving Value at the Bedside) and Dell Module Collection 4 (Improving Value in Systems) 
   
   1. Complete Self-paced online Modules 6-10 (5.5 hours)
3. Group Discussion at end of week 2 2 hours
   
   1. Students will share at least 1 impression from readings or modules at start of session and 1 take-away from session at end
   2. A facilitated group discussion with students presenting and leading discussions on their assigned module (individual or group) either using their own questions from materials or personal experiences

Value Based Care Experience Paper (Due by 5pm of 2nd Friday of the elective period): At the end of the elective, students will complete a 2 page paper of their experiences with value while on their 3rd year required clerkships. Students may explore any aspect including experiences at the bedside in conversations with patients, thoughts on larger hospital systems, issues of healthcare waste or patient harm, barriers to HVC, to anything in between. Students will be asked to commit to 2 elements of improving value, 1 new approach to communication with patients and 1 new approach to engaging colleagues that they will look to incorporate into their practice going forward.