When I was in veterinary school in the early 1990s, we were taught to always offer the gold standard in pet care. That approach came from good intentions: One should never judge a pet owner’s abilities, financial or otherwise, and thus, you should lay out a treatment plan reflecting the best option. The challenge, however, is that there are many variables to consider related to the provision and outcome of care and whether the treatment meets the expectations of pet owners and clinical teams. In reality, the idea of a best option has always been subjective.
Further complicating the effort to deliver the gold standard is that while continued advancements enable higher levels of care, a confluence of factors is increasingly impeding our ability to provide that care. The traditional ways of approaching pet health care just won’t work.
Challenges Facing Our Profession
Pet ownership and the demand for care that goes with it were rising before the pandemic and skyrocketed in the early days of COVID-19. Meanwhile, veterinary professionals are leaving the profession in droves, partly due to long hours, frequently understaffed hospitals, emotionally taxing work and student debt. Dr. Jim Lloyd’s recently published work, commissioned by Mars Veterinary Health, detailed the shortage of veterinary professionals. The outlook is grim. By 2030, the United States will have an estimated shortfall of nearly 15,000 companion animal veterinarians. That number translates to 75 million pets potentially unable to receive veterinary care.
In addition to the service shortfall, rising prices at a time of economic uncertainty put veterinary care at risk of being financially out of reach of a growing number of pet owners.
The cumulative impact of these challenges cannot be overstated. The sustainability of the veterinary profession — and, with it, the accessibility of quality care for pets — is at risk. With no quick fixes available to ease the supply-and-demand curve in veterinary care, a shift toward leveraging available resources as effectively and efficiently as possible is critical. Evolving the delivery of care to reflect a value-based model represents our best opportunity to change the current trajectory.
What Is Value-Based Care?
At its simplest, value-based care (VBC) aims to provide the best possible outcome for a patient at the lowest possible cost. But if only it were that easy.
First, VBC requires a holistic view focusing on the expected patient outcome as the true measurement of success. Health care teams consider not just the best available evidence and research but also the individual patient. They try to understand priorities, abilities, limitations and resources and then seek the best possible outcome given those variables. The goal is to provide the care that matters most to pet owners, who are balancing their needs and the patients’.
Second, VBC has implications for payment models. Both human health care and veterinary medicine are essentially volume-based, fee-for-service models, regardless of insurance, payment plans and out-of-pocket payments. Incentivizing outcomes and the efficient use of resources over volume and fees is a difficult shift.
And third, VBC requires that we measure outcomes both subjectively and objectively.
Bringing It to Life
We have a chance to provide value-based care without bringing in the complexities and third-party control of human health care’s payer-provider models. Already underway are new efforts, such as the expansion of telemedicine and the 2021 launch of the Spectrum of Care concept at Ohio State University’s Stanton Clinic.
Even staying within today’s fee-for-service model, we can still focus on client priorities and share accountability for the outcomes. As a first step, I advocate for engaging differently with pet owners to set expectations, use available resources better and measure outcomes.
We can look to groups like the International Consortium for Healthcare Outcomes Measurements to inform our value-based strategy. In partnership with physicians and patient representatives, the consortium developed standards sets for the most prominent disease burdens in human health. For example, clinical factors in managing breast cancer include objective measures such as disease recurrence and surgical site infection, while non-clinical elements include the development of depression, maintaining a healthy body image and the patient’s quality of life.
Going condition by condition and client by client is daunting, but that’s not a good enough reason not to get started in the veterinary world. An orthopedic issue? A good outcome that meets expectations for one pet owner might be ensuring that her couch-potato dog no longer limps. Another pet owner might expect her dog to join her on morning jogs. A chronic medical condition? One client will be happy not to have to pill his cat daily, whereas another will give any daily medication to avoid putting his cat through a procedure.
Understanding differing client values and expectations requires a holistic approach — thoroughly engaging pet owners, considering clinical and non-clinical variables, and setting a plan to achieve the desired (realistic) outcome. With survey tools serially capturing the client experience, the patient’s quality of life and clinician assessments, we can decrease gaps between how clinical teams and clients perceive outcomes and the patient experience. And we remove waste from the system by achieving the holy grail of right care, right place, right time.
Pick Something to Get Started
We can’t carry on with the current approach while our profession struggles, nor can we allow pet health care to become a luxury few can afford. Value-based veterinary care is not a silver bullet, but it could address some of our profession’s biggest challenges and improve the pet care experience. Here are a few ways get started.
- Avoid repeating the mistakes of human health care’s third-party payer system. With pet health insurance still representing a relatively small percentage of U.S. veterinary patients, we have an opportunity to shape the system to benefit pet owners and providers.
- Evolve the fee-for-service model to not only reward the ability to meet the demand for care and maintain high caseloads but also measure and incentivize desirable outcomes.
- Start to articulate this equation: Value is outcome divided by cost. Outcome is a combination of subjective and objective inputs. Cost includes pet owner prices and what we spend to deliver veterinary care.
- Find, build and utilize better tools and technology to capture and use data. We won’t understand the choices that lead to better outcomes if we can’t repeatedly and reliably measure what is happening.
- Start small by focusing on one or two conditions to understand the variability in expectations and outcomes achieved. Then, apply those learnings to other conditions and expand gradually.
- Engage the right people. Build a diverse team energized by thinking differently and being involved in the transformation.
Value-based care reminds us that the gold standard is in the eye of the beholder. Developing a treatment path that’s best for each situation is infinitely satisfying for all involved. It’s the true art of practice. We owe this type of care to our beloved pets and their owners, and we need transformation to sustain the veterinary profession.
A PLODDING JOURNEY
Human health care has tried to implement a value-based model for decades, but gaining traction has been challenging, in part due to the complex nature of the payer-provider model. Moving away from a volume-based, procedure-driven, fee-for-service model to a system incentivizing outcomes is complicated, as is measuring those outcomes. In human health care, the variability in outcomes, as measured across any number of factors, is shocking. For example, according to the Organisation for Economic Co-operation and Development, a 13-fold variability in maternal mortality rate exists across similar economically developed countries.