In what was, to state the obvious, a tumultuous year in health care, perhaps nothing caused more angst than the move away from a volume-based payment system. In many ways, value-based reimbursement is still an embryonic concept, and everybody from policymakers to payers and providers are struggling to sort out exactly what "value" means. Is it simply balancing care against cost? How do you measure quality across a continuum of multiple providers? At what point do you decide an outcome is the outcome, especially for chronic conditions? Can less care equal better care in certain cases? And how in the world do you get paid for not providing something?

Hospitals & Health Networks, Health Forum and VHA Inc. recently convened a panel of hospital leaders from around the country to share their definitions of high-value health care and the strategies they're using to meet — and survive under — the new and still evolving mandates. The discussion touched on areas that hospital executives and boards everywhere are struggling to get their arms around.

At Advocate Good Samaritan Hospital in Downers Grove, Ill., talk about value centers around "delivering safe care that follows evidence-based best practices," said President David Fox. "It's about delivering care in a compassionate and caring way for the patient and family members. And, of course, it's increasingly about delivering care that's affordable."

Todd Linden, president and CEO of Grinnell (Iowa) Regional Medical Center, echoed Fox's definition. "We provide care in a way that's personal and safe and affordable," he said, noting that, especially in a small community, it's "being able to look people in the eyes and know that we met their needs and improved their quality of life."

Julie Manas, president and CEO of Sacred Heart Hospital in Eau Claire, Wis., put it succinctly: "We define it as perfect care, which means we did the right thing for the patient at every encounter."

Enhancing health care value increasingly means taking costs out of the system, to reduce the burden on individuals and the national economy and to position hospitals and other providers to remain viable as reimbursements tighten. That entails looking at the organization in each of its parts and across its entirety to eliminate variation and inefficiencies. It's something Scripps Health Care in San Diego has done aggressively.

"We flipped the organization on its side a few years ago," said Vic Buzachero, corporate senior vice president for innovation, human resources and performance management. "We created a horizontal co-management model to identify and eliminate variation."

It's worked. Over the last 36 months, Scripps identified more than $200 million in duplicate or excess costs in such areas as physician preference items, supplies and equipment. Moreover, the system combined its education and orientation efforts across all its hospitals "to streamline processes and reduce costs," Buzachero explained. "We've set a goal to reduce expenses by another $100 million over the next 12 months."

The panelists talked about how to tackle other crucial elements that go into creating high-value care: engaging patients, transparency with boards, data that pinpoint best practices and inspire physicians to come on board, and, crucially, building a strong continuum of care with other providers in the community.

But panelists agreed that enhancing their value to the communities they serve involves far more than providing effective treatment for the ill.

"We are essentially in the quality-of-life business," Linden said. "We have to make the transition of helping people recognize our institutions are beacons of health, and not just a place for them when they're sick or injured."

The full roundtable discussion appears in the December issue of H&HN. You can read it here.