Costs and system-wide considerations within head and neck reconstruction: moving toward a value-based care framework.

Abstract

Purpose of review: Head and neck (H&N) reconstruction presents unique economic and system-wide considerations due to the resource-intensive nature of reconstructive techniques, such as free flap reconstruction and multidisciplinary perioperative care requirements. This article highlights the current cost and price drivers within H&N reconstruction. In addition, we review challenges and initiatives to address these drivers and consider a framework for value-based care (VBC) interventions in H&N reconstruction.

Recent findings: H&N reconstruction cost drivers include operative time, postoperative monitoring setting, and complication management within the surgical global period. Current system-wide considerations for H&N reconstruction include operating room and specialized workforce availability, postoperative intensive care unit utilization, and streamlined perioperative care pathways such as enhanced recovery protocols. Early VBC interventions have shown promise through length of stay reduction and cost containment, however, there is significant opportunity for further aligning reimbursement with drivers of costs and outcomes for H&N reconstruction.

Summary: While previous efforts have predominantly focused on cost drivers in the perioperative period, significant opportunities exist to further align cost-saving measures with better outcomes across H&N reconstruction care. A framework for VBC in H&N reconstruction supports the development of interventions to align cost and price drivers with value.