High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians.

Abstract

Purpose: Physicians are estimated to be responsible for more than 50% of national healthcare costs and hold the greatest potential to improve value by orchestrating quality-driven programs to reduce unnecessary practices and variability. A physician's ability to practice cost-conscious care has been linked to their training, underscoring the importance of integrating cost-conscious practice into training.

Methods: The High Value Practice Academic Alliance was formed to help advance the value-improvement work of individual institutions through a national organization. We developed a curriculum and mentorship model for trainees throughout the country titled the Future Leaders Program (FLP). Upon entry to FLP, GME physicians completed a baseline self-assessment of their knowledge about costs, payment, and value in healthcare. Over 1 year, these physicians participated in structured educational activities related to high-value care (HVC), received mentorship focused on leading a value-based quality improvement (QI) project, and then completed a second self-assessment upon completion of the program.

Results: Over four academic years (AY17-18 through AY20-21), we had 161 respondents. Most participants report some prior education in healthcare value; however, many had never participated in a QI project. Participants showed variability in their knowledge. After completion of the program, paired sample t-tests demonstrated significant differences in the subscale scores for value knowledge (M =  - 0.63, SD = 0.93), attitudes (M =  - 0.46, SD = 0.45), and skills (M =  - 0.40, SD = 0.71) indicating that participating in a value-focused QI project improved value knowledge, t(160) =  - 9.66, p < .001; attitudes towards high-value care teaching, t(160) =  - 12.48, p < .001; and high-value care practice frequency, t(160) =  - 6.93, p < .001.

Conclusions: Skills and knowledge are significantly improved after completion of our program, demonstrating that a free, web-based curriculum and tiered mentoring program can be effective in teaching HVC skills and preparing physicians to lead this work.