The Chronic Care Reset: Transitioning From Volume to Value

America is aging, and not gracefully. Despite longer life expectancy, today’s generations are sicker than their parents. Half of all adult Americans have at least one chronic condition; more than 20 percent have two or more. Hypertension. Coronary artery disease. Diabetes. Unfortunately, the U.S. health care delivery and financing system isn’t designed to serve individuals with multiple lifelong and often lifestyle-affected chronic diseases. In fact, it’s failing at the task.

Scott Wallace and Elizabeth Teisberg, professors at Dartmouth’s Geisel School of Medicine, call it a pandemic of chronic disease, but they also believe the pandemic can be stopped and the diseases can be effectively treated – and even cured. The antidote centers on the patient, and requires a mindset shift from volume to value.

“To break the downward spiral, providers need to transform their services, offering tightly integrated, lifestyle-focused, continuous care addressing patients’ unmet health needs,” they wrote in a recent Becker’s Healthcare article. “Doing so will slow and sometimes even reverse the progression of chronic conditions.”

The expert duo, whose highly successful onsite, interactive and customized workshops are helping organizations redefine health care, offer five fundamentals for reorganizing chronic care to improve health outcomes:

  1. Start with the patients. Successful chronic disease care happens when teams of caregivers work with patients over extended time horizons and they co-create health.
  1. Address lifestyle, not behavior. Health is co-produced by the individual’s lifestyle and the care he or she receives; clinicians need to work with this reality.
  1. Structure around health-based segments. Organizing around groups of patients with similar needs, co-locating services and tightly integrating teams of caregivers improves efficiency and effectiveness.
  1. Think health, not just medicine. Decisions about what services are included and excluded should be made on the basis of whether they efficiently improve health outcomes.
  1. Leverage clinicians. Provider organizations that structure care so clinicians practice at the top of their licenses gain tremendous leverage by using health coaches, educators, social workers, navigators or successful patients in care delivery models.

“Care organizations need to create a strategy based on unique value creation and tradeoffs that allow them to develop and deliver excellent care,” emphasizes Professor Wallace, who works in the U.S. and around the world with employers, health care providers, health plans, governments and others to conveniently and effectively treat chronic conditions, create employee health strategies, and develop new health benefit and care delivery models

You might also be interested in related commentary around Professor Teisberg’s recent presentation on value-based care at the annual meeting of the American Association for the Study of Liver Disease. With deep background in strategy and innovation, with special attention to the health care sector, she draws from years of close collaboration with renowned authority on competitive strategy and value creation Professor Michael E. Porter.

To learn more about Professors Wallace and Teisberg’s workshops, visit

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