A Surgeon's Field Guide to Value-Based Specialty Care

Document Type

Journal Article

Publication Date

8-1-2025

Journal

Laryngoscope investigative otolaryngology

Volume

10

Issue

4

DOI

10.1002/lio2.70239

Keywords

EM3; accountable care; care‐coordination; episode‐of‐care; patient experience management; patient journey mapping; synoptic reporting standards; total cost‐of‐care; value‐based care; value‐based referrals

Abstract

OBJECTIVE: To provide a comprehensive state-of-the-art review from the perspective of the surgeon and the surgical specialty academies of the conceptual shift from a volume-driven fee-for-service payment model to one of value-based accountable care payment. This field guide attempts to clarify drivers of surgical value-based performance and outline a comprehensive strategy to successfully engage this healthcare reform paradigm. DATA SOURCE: Pubmed/MEDLINE/Google search. REVIEW METHODS: Pubmed/MEDLINE/Google search was performed during June 1, 2024-May 17, 2025 for value-based initiatives, administrative, and government agency publications, Centers for Medicare and Medicaid Services, and Center for Medicare and Medicaid Innovation value-based care policy, directives, and programs. CONCLUSIONS: The transition from volume-based to value-based payment models necessitates rethinking how surgeons define, quantify, and engage the care they deliver. The social contract between the surgeon and patient is poorly aligned within the current fragmented fee-for-service payment model. Relative value units continue to function as a poor benchmark measure of the physician-patient relationship, which is foundational to achieving consistent patient engagement and favorable clinical outcomes. To facilitate this value-based realignment within surgical care, we introduce a novel three-dimensional framework for patient experience management (EM) focusing on three core elements driving value-based surgical care: clinical outcomes, patient engagement, and episode-of-care spend. EM is proposed as a strategic roadmap to operationalize episode-of-care transparency within the traditional value equation: Value = Outcomes/Cost. EM lays out a comprehensive pathway to facilitate improvements in surgical value-chain competency, team-based care leadership, and longitudinal care management skills. These represent the essential core components for competitiveness within a new era of performance metrics relevant to alternative payment arrangements within bundle payments and value-based referrals. At the academy and peer-review leadership level, each surgical specialty will need to invest in developing clinically valid next generation assessment measures and care plans encompassing EM dimensional elements to remain both relevant and competitive in a new era of evolving accountable care models.

Department

Surgery

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