title: Measuring value at the provider level in the management of cleft lip and palate patients.
abstract: "Value" has become a buzzword in current health-care discussions. This study demonstrates a provider-led strategy to measuring costs, an understudied component of the value equation, for a complex diagnosis for the purposes of improvement. A retrospective, microcosting methodology was used to measure costs for all hospital and physician services and costs to the patient over 18 months of multidisciplinary care for patients with cleft lip and palate. Short-term outcomes were also recorded. Overall costs to all parts of the system ranged from $35,826 to $56,611 for different subtypes, and insight was gained into major cost drivers and variations in care that will drive internal improvement efforts. It is critical that providers learn to work together and become familiar with their own costs in conjunction with outcomes as insurers increase pressure to reduce payments or accept alternative payments so that well-informed decisions can be made.
authors.affiliation: From the *Harvard Medical School; †Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA; ‡Keck School of Medicine of the University of Southern California and Los Angeles County + University of Southern California Medical Center, Department of Surgery, Los Angeles, CA; and §Harvard School of Dental Medicine, Boston, MA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Abbott
authors.forename: Heather
authors.initials: H
authors.lastname: Rosen
authors.forename: Philipp
authors.initials: P
authors.lastname: Kupfer
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
mesh_terms: D002971:Cleft Lip / Q000191:economics* / Q000601:surgery*; D002972:Cleft Palate / Q000191:economics* / Q000601:surgery*; D003299:Cooperative Behavior; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics; D014481:United States; D062505:Value-Based Purchasing / Q000191:economics