Practice variation: The degree to which health care delivery differentially affects value. Quadruple Aim: A value-based health care strategy that seeks the following: (1) improve the patient experience (2) improve the health of populations (3) reduce the cost of care and (4) improve the provider experience. Value-based pricing: A pricing model for therapy in which the reimbursement price of therapy depends on the outcomes that the therapy produces, and in which better outcomes can justify a higher value-based price. More broadly, value-based care encompasses the concepts described in the Quadruple Aim of health care. Value-based care: In contrast to volume-based care, value-based care is a complex synthesis of health care delivery that incorporates outcome (and process) measures in physician reimbursement. The specialty of allergy and clinical immunology touches every aspect of medicine as such, the practicing allergist/immunologist plays an integral role in an ever-evolving health care system to deliver high quality, value-based care. These tenets have encouraged innovation, such as understanding practice variation and benchmarking best practices, critically appraising evidence and clearly translating recommendations, rethinking health care delivery models and financing, and increasing focus on social and behavioral determinants of health ( Table 1). 1 Goals include (1) improving the patient experience, (2) improving the health of populations, (3) reducing the cost of care, and (4) improving the provider experience to prevent physician burnout. 1 Toward a shared end, the Quadruple Aim to achieve value-based care has emerged as a guiding principle for health care systems to accomplish high-quality care. But despite rapidly advancing medical knowledge, there is variation in global health care delivery even with the consensus that any clinical strategy offered should be safe, effective, patient-centered, timely, efficient, and equitable. Substantial breakthroughs have expanded the clinician’s ability to offer the latest diagnostic and therapeutic treatments to patients to reduce morbidity and mortality. The practice of medicine is evolving at a rapid pace. Clinician wellness must be made a priority for continued effective practice. Although efforts to incentivize value-based care have emerged in recent years, the degree to which process measures improve patient-important outcomes remain uncertain. Food allergy prevention, newborn screening for severe combined immune deficiency, and penicillin delabeling are examples of population-based opportunities in which allergists and immunologists can assist in creating health care value. Although evidence suggests that shared decision-making and addressing social determinants of health have critical roles in high-quality care, some practices such as routine laboratory screening for urticaria, premedication to prevent recurrent low- or iso-osmolar contrast reactions, extended observation of resolved anaphylaxis, food allergy screening, and penicillin allergy overdiagnosis have high costs in relation to overall societal benefit. Efforts to improve cost-effective care can be informed by understanding unwarranted geographic practice variation and benchmarking best practices.
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