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Is the cost of health care a barrier between providers and their patients?

Diane Liu


Under University of Utah Health Care’s Value-Driven Outcomes initiative, more than 6,000 staff and faculty have logged on or signed up for face-to-face training seminars. Collectively they’ve developed more than 750 value projects, 180 measures of quality, more than 100 tests of service and 109 cost benchmarks. 

Pediatrician Diane Liu, M.D., has signed on to the Value Improvement Leadership team, a group of highly-motivated providers who are constantly reviewing system costs and figuring out how to provide precision medical care at the best possible cost for patients.

Editor’s Note: Instead of focusing on curriculum design, we’re celebrating people who are already lifelong learners. They’ve taken on the responsibility to learn new skills and are helping create a system that supports that kind of learning for others. They’re changing the culture.

Q: Why is health care cost analysis taking off now?  

A: Quality improvement isn’t new, but now more than ever front-line staff can touch the change process and make an impact. The only way we can touch that is if we have information about what we’re doing. Because of transparency initiatives, our fundamental knowledge about costs and service within all levels of health care delivery has grown. Never before have we had so much data about what we’re doing. And large systems with a lot of data can really target efforts.

We’re coming together better than ever before. And sponsoring leaders who embrace value are blazing that trail.

Q: What drives your passion about bringing the costs of medical care down?

A: Early in my career, I was asked to participate in quality improvement at a provider level. I realized the power of fee-for-service and tremendous volume involved ambulatory patient care. My role was really auditing my colleagues, and it was punitive. I knew that was not ideal. I knew there was no learning from that experience for either my colleague or myself. I realized very quickly that this was not the best way to approach improving care.

Then I joined a nonprofit that cared for patients with medical complexity throughout their lifespan. With our partners at CMS, we were able to put in place systems that would improve the care we provided while reducing costs. The value-based payment world was quickly becoming a reality for us. Though we were a relatively small organization, we were large enough to have a footprint in the communities we served.

Payment reform was a reality for us. It gave us an opportunity to learn together as an organization, but also as human beings. We were functioning as an organism—co-located, integrated electronic health records, the same ground rounds, the same leadership. We were all working together. We were committed to our patients, but we also were committed to one another and the organization’s ability to tackle all aspects of value simultaneously.

Q: How can systems break down barriers to building this kind of model?

A: Leadership vision has to be felt by front-line staff. System transparency is critical. And strong leaders create the necessary ‘space’ for front-line staff to be able to communicate safely. That’s the only way you can learn from each other. When you have a really constructive, motivated group of human beings who have a common vision, that’s when the learning happens. We learn as an organization.

Q: What responsibility do providers have to keep learning?

A: I was taught about lifelong learning in medical school, but back then I didn’t understand what it was going to mean for my future as a clinician.

A clinician must have enough humility to recognize that the information she must know is vast enough that mastering it requires more of providers than at any other time in the past. The cognitive load for health care information is at the point where mastering it as a trainee, as a clinician, absolutely requires a commitment to lifelong learning.

Q: How do students learn best?

A: I’m committed to making sure the pathway behind me is clear. Walking into walls is not the most effective way for students to learn. Learning by trial and error is important, but as a teacher I have a profound commitment to preparing trainees for the future of health care delivery. I hope to inspire students to genuinely understand problems and not just arrive at solutions. We have to be more thoughtful about the learning process. Our students can make the difference in that process.

Q: What keeps you up at night?

A: I’m driven to break down anything that gets between us and our patients. It is such a privilege to be a part of somebody’s life, to be invited into a family’s crisis—especially the life of a dying child.

I had to tell a mother—through an interpreter who was on the phone—that her child had died. It was the “best” we had in terms of communication for her specific language, but it felt like such a tremendous failure. She collapsed in my arms. As a doctor, you learn how other people suffer. That is truly life-changing.

By: Rebecca Walsh

Rebecca Walsh is a Senior Writer for University of Utah Health Sciences.