Choosing Value Over Volume

If it feels like you’re paying a much higher price for the same healthcare than you were a few years ago, you’re right.

And you’re not alone.

Healthcare spending at the individual and government level has increased exponentially in the past decade, as shown below.

From providers to payers, innovators to government officials, many in the U.S. healthcare community are finding that these increasing costs are not always improving patient outcomes. As a result, the healthcare space has been gradually undergoing a paradigm shift for the past few years: moving from healthcare that is volume-based to value-based.


Quality Versus Quantity

The difference between the two is in how hospitals and physicians are reimbursed by insurers for their services. In volume-based healthcare, providers are paid fee for service, based on how many times they treat patients, as opposed to how beneficial those treatments are.

In value-based healthcare, as the name suggests, providers are reimbursed based on the value their treatment brings to the patient, as opposed to just the treatment itself. Payments are based on patient health outcomes. Providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.


Driving the Change

Currently, insurers are the primary drivers of this change. The CMS (government body that oversees Medicare and Medicaid) now allocates $2 billion dollars annually for value-based reimbursements2. Other private insurers such as Blue Cross Blue Shield and Aetna are following suit by pledging certain percentages of their budget for value-based systems3,4. These insurers have their own metrics and surveys (you may have heard of HCAHPS) to assess hospitals’ achievements in areas such as mortality and complications, patient safety and experience, and efficiency and costs of processes. How much the insurers reimburse is then reflected by how much value hospitals bring to each of these areas.


The Future of Value-based Healthcare

In this next decade, emerging technology will play a huge role in helping insurers and providers usher in this value-based system. Below are some examples of these technologies that are currently being developed:

• Telemedicine and wearables are allowing providers to more closely and consistently monitor patient health, without the associated costs of seeing them at a hospital or clinic.
• Machine learning algorithms are analyzing large sets of health data to aid physicians to identify issues before they even happen, shifting the focus to cheaper preventative medicine.
• Improvements in healthcare IT are bridging the information gaps between physicians, patients, and insurers, providing data-driven insights into which specific areas in the healthcare system can be improved to provide more value.

Technology is changing this medical landscape as we know it. But the future of value-based healthcare also depends on a confident and informed patient. This is a patient who creates personal health data, is aware of what they want out of their healthcare, and actively engages in healthcare discussions to voice these values (more on this here). A value-based system has no meaning until patients come together with providers and insurers to arrive at a shared definition of valuable healthcare. So, as you navigate your health journey in this increasingly value-based system, know what you value and share it.



1.The Huffington Post. “Why US Healthcare is Obscenely Expensive”. 2013. Web.

2.US Centers for Medicare & Medicaid Services “CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2018”. 2017. Web.

3.Blue Cross Blue Shield. “Blue Cross and Blue Shield Companies Continue to Lead Nation’s Path to Value-Based Healthcare”. 2015. Web.

4.Aetna. “Joint ventures improve member care, reduce costs”. 2018. Web.

Take Charge of Your Health

Don’t be a passive patient.

Truly personalized medicine depends on one agent of change: the patient. Leading your own healthcare journey depends on taking actions. Taking action takes confidence and persistence. Here are some essential steps we recommend to get going and stay the course:


The obvious big picture goal is to recover and live your healthiest life possible. But this overarching aim to just “get better” can sometimes be impersonal or out of scope. Add personal meaning to goals by making them more specific to how they will improve your life. From there you can drill down into the numbers that need to change.

Take the example of high blood pressure. Current target guidelines are below 120 over 80. If your blood pressure is moderately above this guideline, say 128 over 85, it’s simple to acknowledge that it’s high and needs to come down over time. However, it likely doesn’t inspire a consistent and rigorous commitment to actions on a daily basis.

By contrast, translating high blood pressure to life is very inspiring, as it leads to issues such as:

  • Increased risk of heart attack, stroke, vision problems, and sexual dysfunction
  • Higher susceptibility to negative health events due to stress or rigorous activity
  • Greater difficulty in returning to normal levels as one ages

With this knowledge, ask yourself: what about lowering your blood pressure means the most to you? As a result, your true goals may look like these:

  • I want to look and feel great at my kids’ weddings
  • I want to run a marathon
  • I want to have a great sex life as I get older
  • I want to take the risk of starting a business and be healthy enough to handle the stress

Getting below 120 / 80 now means a lot more.


Now it’s time to get into the concrete details. Work with your healthcare team to come up with the highly-specific actions that will get you to your goal. High specificity makes the actions easy to track and simple to commit to. For high blood pressure, these might be along the lines of:

  • Eliminate soda from your diet
  • Walk or jog 3 miles per day
  • Meditate for 15 minutes each morning
  • Eat something green at both lunch and dinner

These are simple to comply with because they form a checklist that can be tracked each day. Contrast this with the less specific idea of “eating healthier” or “getting exercise”. These are not wrong, but impossible to track and hence know whether what you are doing is working.


You can use pencil & paper, a spreadsheet, or even a digital health app (our favorite). No matter how you do it, it’s critical to document two things:

1. Actions taken

2. The metric you are improving

In the case of blood pressure, you would document whether you complied with no soda, greens at lunch & dinner, meditation, and distance of your walk/jog. Since these are daily actions, you would track them every day. At the same time, you would measure your blood pressure frequently and establish a trend.

Tracking actions and metrics empowers you in the following ways:

  • Understanding what works: You need to know if your prescribed actions are working for you. If it’s been one month and the needle isn’t moving on blood pressure, additional actions may need to be taken. On the flipside, if it’s working and you’re feeling good, perhaps you can do more, like run faster and farther.
  • Compliance checking: Keep yourself accountable for sticking with your goals. Without documentation, it is easy to trick yourself into believing that you’ve made changes that you actually haven’t. It’s important to know that if the desired effects are not happening whether it’s because you need to try something else or you haven’t been complying with what you originally set out to do.
  • Motivating yourself: Making positive changes are not naturally easy, at least not in the beginning. The first few days can feel like an eternity, especially if the results aren’t showing up right away. Recording the daily victories when you accomplish your goals makes every win real, and can help motivate you to stay on track.


Your healthcare journey is much easier and enjoyable when shared with others. There are many individuals around you that can and want to be a part of it. Take the initiative to reach out to the following networks for support along your journey.

  • Healthcare team: These are your medical experts and know the technicalities of your health goals. You need them to provide their medical experience and knowledge as much as they need you to provide your expertise in yourself and your body.
  • Family and friends: They may know things about you that are not apparent to yourself that can help you on your health journey. Perhaps they’ve noticed changes in behavior or attitude as a result of high blood pressure that you haven’t realized yourself. Reach out to them for a second opinion or as your social support system to guide and empower you.
  • Other patients: No one patient can know all resources and research available to them. Luckily, there is a high chance that there are other patients going through what you are going through. Plenty of online and in-person patient communities, like this, exist where stories and experiences are shared. Utilize this collective knowledge to enable you to make more informed medical decisions.

Researching Health Topics with Confidence

More than ever, we have the power as individuals to make excellent healthcare decisions for ourselves and our families. Connectivity between patients and accessibility to research & education have proven to be powerful tools in fighting health battles, yet as a population we still do not leverage the information available to us very often.


It’s both too much and too little information at the same time. All the information in existence is of no use if we cannot extract and make use of the small portion that is relevant and credible. The stuff we really need is drowning in the stuff we don’t. This is why research often feels daunting and leads to many of us giving up.

To cut through the clutter and truly turn health research into a powerful tool, we recommend the following process:


A strong vocabulary on the health topic you are researching serves as the platform you need to effectively find and use the right materials. Vocabulary enables you to:

• Accurately articulate your symptoms and condition to your healthcare team and family
• Perform deeper research with more precision
• Understand and use deeper research when you read it

Let’s examine the case of a torn meniscus. Without a vocabulary, one would likely perform a web search for “knee injuries” or “knee pain”. The results of that search clearly illustrate that there will be lots of irrelevant information and much of it will be hard to understand because there is no foundation to build on.

It is much more productive to take some time up front to learn about the knee through a basic information tool such as WebMD. From there, it becomes much easier to perform more specific research on your symptoms and communicate accurately with your doctors.


Perhaps the biggest problem with having so much information available is that a large amount of it could actually be counterproductive or harmful. This fact can make research difficult to do with any sort of confidence. These rules of thumb will make deeper dives effective:

Source Credibility: Use objective, scientific content published by experts in the field. Scholarly journals are peer-reviewed and are reliable. Popular periodicals (e.g. magazines or newspapers) do not carry the same scientific rigor and are inherently subjective. Here is a concise guide to sourcing scholarly journals.

Timeliness: Newer is better! Look for the most up-to-date content for the topics you are researching.

Learn to Love Ambiguity: There will be times where two perfectly credible and up-to-date sources come to different conclusions. This is okay! There are very few situations in healthcare where there is one right answer to a problem. This is a perfect time to engage your doctor with your findings and think through what it means for you as an individual.

Embark on the Journey with a Friend: When we work with another person on research projects, our critical thinking abilities increase and we glean more insights from a session. If possible, engage someone to help you.


Research only becomes a powerful tool when put into action. The two keys to success are:

Make it About You: Pair your research findings with your own personal data (more on personal data here). In the case of our meniscal tear example, you should pair your research up with what you know about yourself: age, degree of soreness, range of motion, length of time you’ve had the pain, physical activities you were engaged in when pain first occurred, and so on. As you work with your doctors, data will be continuously generated. Track it! It will lead to even more specific research and actions you can take.

Team Up with Your Doctors: The value of consultations with your doctors exponentially increases when you come in as a well-researched patient. Your healthcare team is one of the best research resources because they can give you feedback right there on the spot, and they will ensure you are comfortable with your diagnosis and treatment. If you are transparent and comprehensive with your doctors, you will be able to competently and confidently fight any health battle.

Make Your Medical Data Meaningful

20,000 sand grains. 33 rocks. 18.5 umbrellas.

This is data, and it’s meaningless. Does it describe a beach? Maybe. But there isn’t enough of a story here for anyone to even care what it describes.

When presented in isolation, data communicates nothing of actionable value. This has become a significant problem in healthcare. We capture more health data than ever, yet not much has improved in the way we make meaning of it and act on it.

For all the hype surrounding big data and the glamour of data-centric cultures, the truth is that the story is what’s important. Data is simply a useful tool to help tell that story. In the case of your health data, the important question is what story does this tell me about my health? Like any good story, the state of your health at this very moment has a setting, a plot, an interesting backstory, and all sorts of paths you can take which will have different conclusions.

The core tool that you can use to tell a story with your data is context. Here are five important elements of context that you can apply to any health data to make it meaningful and actionable.


1. Range: Typically, there are data guidelines for any specific health topic. Consider a cholesterol level of 210, for example. Finding the established range is the first step in making this data point useful for you.

2. Trend: Examining the same measure repeatedly over time is crucial to understanding the meaning of health data because it shows where you’ve been. Cholesterol at 210 today has a much different meaning if it was 240 a year ago vs. 180 a year ago.

3. Related Data: Data is always related to other data. Sometimes those relationships are causal, but even when they are not these relationships are important to understand. Since cholesterol level is often used to measure risks for heart disease, related data will also likely include weight, blood pressure, medications, diet, and exercise. When examining the trend of cholesterol against the trend of these related measures, correlations may appear that can be further explored with your doctor. For example, a drop from 240 to 210 over the past year might coincide with the fact that you are currently taking a cholesterol-lowering medication. But it might also correlate with greater levels of exercise and developing a leaner body.

4. Risks: So what’s the big deal? We don’t worry about high cholesterol simply because it’s out of the normal range. We worry about prolonged high cholesterol because it greatly increases the risk of heart attack. You can know that a value is out of range, but you must know its implications to understand its clinical significance.

5. Remedies: If there is a desire for improvement, what are the options? Knowing the treatment options enables you to choose the best course of action based on your understanding of the data, lifestyle preferences, benefits, and risk. For instance, high cholesterol can be alleviated with regular exercise and healthy eating or may require medications for a more chronic or severe case.

Using these elements of context will empower you to work with you doctors and family to understand and act competently on your data. Whether you are fighting a health care battle or are looking to optimize your fitness, we encourage you to use these five data context tools to tell your story and make empowered choices.