The value of dividends in health: a call to align stakeholders.

Objective: The purpose of this paper is to describe the philosophy and utility of value-based designs (VBDs), with an eye toward defining a pathway for a shift to VBDs across US businesses involved in the health care discussion.

Methods: A 12-question survey of 36 companies that had been identified as emerging leaders in health and productivity management was administered by telephone interview and, later, by online interview. Information collected included company size, business sector, prevention, wellness, data accessibility and integration, condition management, C-suite visibility, and culture of health. Answers were scored on a scale from 1 to 10 per category; the maximum score was 50 points. These scores were used to indicate patterns of development and define the pathway to maturity. Experts resurveyed the data to quantify change over time, which was used as a proxy for dividends. A pathway, or continuum, was graphed based on the scoring.

Results: Three segments were found to be clearly correlated with the reported experiences from the surveys-patterns of data use, targeted population change, and services and metrics. The movement through the continuum begins with a focus on prevention and wellness across the entire population, next uses data to identify current waste (inefficiencies in specific segments of the population regarding chronic care, accessibility, and quality/reimbursement, and inefficiencies in care delivery), and finally merges the total health and wealth of segments of the population into one coordinated strategy to maximize the total health value of every dollar spent at the individual and system level.

Conclusions: The market for VBDs has grown rapidly. The pathway to success-including the data needed, designs created, services acquired to change behavior, and dividends over time-can be shown to be replicable, scalable, and sustainable.