Value-based Healthcare: Measuring What Matters-Engaging Surgeons to Make Measures Meaningful and Improve Clinical Practice.

The long-standing management tenet, “what gets measured gets managed” is likely influenced by the Hawthorne effect, which holds that individuals modify their behavior when they are aware that they are being monitored. With bundled-payment programs like the Comprehensive Care for Joint Replacement model, Bundled Payments for Care Improvement, and the Quality Payment Program already underway, we believe that these initiatives have generated a Hawthorne effect among surgeons who are now well aware that they are being observed. Linking reimbursement with both cost and outcomes provides surgeons with a motivation to improve, and the associated measurement (by payers and health systems) gives orthopaedic surgeons visibility into opportunities to deliver higher-value care to our patients [6]. While the interest in, and dependence on, robust and reliable measurement is steadily increasing to support the transition to fee-for-value reimbursement, the field of healthcare analytics is still nascent in its development; as we are still in the early stages of learning how to translate “big data” into meaningful and actionable information that improves clinical outcomes [3]. Successful development and dissemination of clinical and operational measures is dependent on both a structured surgeon engagement model and a robustmetrics-definitions process. Previous authors have addressed the need for increasing surgeon awareness to measures that reflect their financial, operational, and clinical performance, allowing surgeons to compare their results to peers and to national benchmarks [4, 5]. Still, healthcare organizations often underestimate the effort required to generate and disseminate meaningful data that is needed to achieve broad-based changes in practice; many assume that one or two meetings and a series of PDFs posted on a bulletin board will transform clinical practice. Advances in healthcare analytics and the vast amount of clinical data available in the electronic health records provide hospitals the opportunity to generate extensive clinical dashboards, but doing so requires a substantial investment in human and financial resources [7]. As part of a broader program to create a learning health system within a community hospital system, Dell Medical School and Ascension’s Seton Healthcare Family in Austin, TX, USA collaborated to develop a structuredengagement model that encourages influential clinical champions, who are engaged throughout the development process, to work with their data analytic partners to create and distribute A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research the latest Value-based Healthcare column (formerly Orthopaedic Healthcare Worldwide). Valuebased Healthcare explores strategies to enhance the value of musculoskeletal care by improving health outcomes and reducing the overall cost of care delivery. We welcome reader feedback on all of our columns and articles; please send your comments to eic@ clinorthop.org. The authors certify that they, or any members of their immediate families, have no commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. K. J. Bozic MD, MBA (✉), Dell Medical School at the University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712 USA, Email: kevin.bozic@austin.utexas.edu