Transition to Value-based Healthcare: Development, Implementation, and Results of an Optimal Surgical Care Framework at a National Cancer Institute–designated Comprehensive Cancer Center

Randall A. Lee, Selma Masic, Joseph Bland, Elizabeth Handorf, Alexander Kutikov, Nestor Esnaola, Jeffrey Farma, Stacey Su, John A. Ridge, Christina Chu, Sameer Patel, Paul Curcillo, James L. Helstrom, Robert G. Uzzo

Research output: Contribution to journalArticlepeer-review

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Background: The continued rise in healthcare expenditures has not produced commensurate improvements in patient outcomes, leading US healthcare stakeholders to emphasize value-based care. Transition to such a model requires all team members to adopt a new strategic and organizational framework. Objective: To describe and report a strategy for the implementation of a novel patient-centered value-based “optimal surgical care” (OSC) framework, with validation and cost analysis in kidney surgery. Design, setting, and participants: An observational study of care episodes at a single institution from 2014 to 2019 was conducted. Outcome measurements and statistical analysis: Multidisciplinary teams defined OSC by core and procedure-specific metrics using a combination of provider-based (“bottom-up”) and “clinical leadership”-based (“top-down”) strategies. Baseline OSC rates across were established, while identifying proportions of OSC achieved by coefficient of variation (CV) in total direct costs. Multivariable linear regression comparing cost between OSC and non-OSC encounters was performed, adjusting for patient characteristics. Results and limitations: An analysis of 30 261 perioperative care episodes was performed. Following the implementation of an OSC framework, there was an increase in OSC rates across all procedure buckets using core (25%) and procedure-specific (26%) metrics. Among the tumors tested, kidney cancer surgical episodes held the highest OSC rate improvement (67%) with lowest variability in cost (CV 0.5). OSC was associated with significant total cost savings across all tumor types after adjusting for inflation (p < 0.05). Compared with non-OSC episodes, a significant reduction in the cost ratio of OSC was noted for renal surgery (p < 0.01), with estimated costs savings of $2445.87 per OSC encounter. Conclusions: Institutional change directing efforts toward optimizing surgical care and emphasizing value rather than focusing solely on expense reduction is associated with improved outcomes, while potentially reducing costs. The strategy for implementation requires serial performance analyses, engaging and educating providers, and continuous ongoing adjustments to achieve durable results. Patient summary: In this study, we report our strategy and outcomes for transitioning to a value-based healthcare model using a novel “optimal surgical care” framework at a National Cancer Institute–designated comprehensive cancer center. We observed an increase in optimal surgical care episodes across all specialties after 5 yr, with a potential associated reduction in cost expenditure. We conclude that the key to a successful and sustained transition is the implementation strategy, focusing on continual review and provider engagement.

Original languageEnglish
Pages (from-to)123-130
Number of pages8
JournalEuropean Urology Focus
Issue number1
Early online dateJul 28 2023
StatePublished - Aug 28 2023


  • Healthcare cost
  • Optimal care
  • Value


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