Value in Health Care Special Issue

Originally published 12 May 2020 | Circulation: Cardiovascular Quality and Outcomes

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This special issue of Circulation: Cardiovascular Quality and Outcomes is focused on value in health care. How we optimize value—defined as outcomes over costs—in the US healthcare system is an increasingly critical issue. We are now in the midst of combating the coronavirus disease 2019 (COVID-19) pandemic, and the US healthcare system is facing unprecedented challenges in caring for patients with and without the Severe Acute Respiratory Syndrome-Coronavirus 2 infection. There are widespread reports of hospitals and health systems not having enough critical care capacity, including ventilators, healthcare staff, or protective equipment to take care of these patients. Further, within a matter of weeks, telehealth visits have skyrocketed to provide continuity of care to patients and mitigate the risk of Severe Acute Respiratory Syndrome-Coronavirus 2 infection. This pandemic has really forced us to rethink the question of value in health care. Despite these challenges, healthcare providers, hospitals, and health systems re-main steadfast in their efforts to deliver optimal care and outcomes for their patients to enhance overall value both to COVID-19 patients and those who continue to need our care in other settings. Goals for these outcomes as outlined by the Institute of Medicine include care that is safe, effective, timely, efficient, equitable, and patient-centered. In this issue, we are excited to highlight work from the cardiovascular community on various aspects of healthcare value. Specifically, there is a summary article from the American Heart Association Value in Healthcare Initiative. This article, led by Dr Joynt-Maddox, focuses on value-based models of care for heart failure. There are original research articles describing interventions at the patient (copayment reduction for P2Y12 inhibitor medications1), hospital (acute myocardial infarction readmission intervention2), and policy levels (Medicaid coverage expansion3) to improve patient outcomes. Further, there is a description of inappropriate medication use among pulmonary hypertension patients who seek care in multiple health-care systems4 and a description of patients’ perceptions of what represents value in health.5 As you can see, there is a wide breadth of focus areas and perspectives on this topic of healthcare value. I hope this is the beginning of a continuing conversation on the topic of health-care value—a subject that is critically important to outcomes research given the outsized role of cardiovascular diseases in American health care. Over the coming months, many of us will be preoccupied with combating the pandemic if we are not already knee-deep in this fight. Ultimately, we will prevail. Once the pandemic is in the rearview mirror, the US healthcare system will continue to face unprecedented challenges as patients come back for care that they have been putting off for months. We will have many opportunities to innovate care, and the question of how we deliver high value care will be of even greater urgency.

Full text of this article is available at