High Stakes, High Value: Revolutionizing Patient Care in Medicine
Meet Dr. Christopher Moriates, a national leader and educator of high value care.
Christopher Moriates, a passionate teacher and advocate for healthcare value, serves as the Executive Director for Costs of Care, a non-profit organization dedicated to transforming care delivery towards a more affordable and equitable healthcare system. He is also the Chief of Hospital Medicine for the VA Greater Los Angeles Healthcare System, and a Professor of Clinical Medicine at UCLA. He previously served as the Assistant Dean for Healthcare Value, Associate Chair for Quality, Safety, and Value at Dell Medical School at The University of Texas at Austin. Dr. Moriates has led the creation of The Choosing Wisely STARS Program, Dell Med Value-Based Health Care Interactive Learning Modules, and the UCSF Cost Awareness Curriculum.
What is your dream vision for healthcare in the next 5-10 years?
A world in which nobody needs to choose between their life and their life savings.
What do you think is the biggest misconception about high value care?
That high-value care is about providing “cheap” health care. People do not want to deliver nor receive “cheap” health care. They want care that is high-quality. But they don’t want to be gouged for it. High-value care is about answering the question, “is it worth it?” (for that individual patient in that individual situation) and if so how do we make sure that you can receive it?
What is the difference between value improvement and quality improvement?
I think of value improvement activities (with the goal of improving the delivery of high-value care) as a subset of quality improvement (QI). Not all QI initiatives improve value for patients, as to be considered value improvement cost must be included as part of the equation. Also many value improvement activities focus on stopping something that we already do but has been shown to not provide value for patients (“things we do for no reason”), and this is different than QI which has traditionally mostly focused on increasing the delivery of evidence-based interventions. We know that for lots of reasons including the psychologic concept of “loss aversion” that it can be even more challenging to “de-implement” practices, so value improvement has its own nuances about how best to pursue these programs.
What obstacles have you faced when implementing healthcare value in initiatives? How do you overcome them?
You need to build the will for change and get people invested in making the improvement before moving toward implementation. Many people want to jump to “EHR fixes” (changing things within the electronic health record), which can be powerful mechanisms for changing behaviors but often these fail if there wasn’t sufficient investment in first gaining buy-in and in truly understanding the reasons driving a particular behavior. At Costs of Care, we developed the COST framework (Culture/Oversight/Systems change/Training) as a way to ensure
you are designing multi-pronged interventions that are more likely to succeed.
You work in several capacities, from Chief of Hospital Medicine to Executive Director at Costs of Care. What is your day-to-day like?
My day-to-day is always changing and I love that. Some weeks I get to work with residents and medical students in the hospital seeing patients and teaching on the wards. Other weeks, I get to sit at my desk while sipping coffee and work on writing a paper or putting together a presentation or advancing our STARS program. Sprinkled through all of that, I meet with and try to provide mentorship and support to many people from students to residents to faculty. And of course there are always lots of zoom meetings, emails, and paperwork, particularly in my chief position. I love the variety of all of the things I get to do. Often it feels like too much of each thing as everything can pile up, but ultimately it is a dream to have the privilege to practice medicine and teach and support others
How can medical students or residents get involved with high value care?
Get involved in our STARS program (https://stars.costsofcare.org/)! Seek and find your people around you that share your interests – if you ask around, I bet you can find local faculty mentors and champions for high-value care and choosing wisely. Follow our non-profit Costs of Care and keep informed about things that are happening.
Any favorite resource content to share with our readers?
Our friends at the High Value Practice Alliance (HVPA) put together a list of free resources, which I think is a great place to start: https://hvpaa.org/maven/. It includes our Costs of Care modules about Cost Conversations and also the Dell Med Discovering Value-Based Health Care modules that I developed. I am a big fan of using the Journal of Hospital Medicine’s “Things We Do For No Reason” article series and JAMA Internal Medicine’s “Teachable Moments” series as teaching resources on the wards.