High-Value Care
Value-Based Care Program
The Value-Based Care (VBC) Program is a Stanford Health Care Program aimed at improving the delivery of high-value care while reducing the cost of healthcare. Dr. Olga Goldberg serves as the Director of Value-Based Care for the Department of Neurology. Neurology VBC projects have focused on designing innovative systems in which our specialists are able to effectively support primary care providers in clinical decision-making.
One major project led by Dr. Goldberg has been “Optimization of Care of Patients Presenting with Headache to a Stanford Health Care Primary Care Provider.” Another project, the “MD2MD Pager Pilot,” facilitated communication among primary care physicians and ambulatory neurologists while the patient was still in the primary care physician's office to address urgent questions, such as whether the patient should be sent to the Emergency Department or for imaging studies. Neurology VBC has also partnered with the Department of Radiology to focus on reduction of unnecessary imaging in patients with dizziness presenting to primary care providers.
Starting in Fiscal Year 2024, the VBC program has been integrated into the Improvement Capability Development Program under the Financial Strength domain. In Fiscal Year 2024, Dr. Goldberg is leading a project to optimize the use of the physical space in the ambulatory neurology clinics as measured by visits per clinic room per day.
Cost Savings Reinvestment Program
The Department of Neurology & Neurological Sciences strives to deliver high-value care. This involves continuously improving the quality and safety of care, and also reducing costs where possible. The Cost Savings Reinvestment Program (CSRP) is a program that benefits both the School of Medicine and Stanford Health Care by sharing some of the realized cost savings from physician-led improvements. Although these funds cannot be used as any form of salary support or compensation for physicians, they can be used at the discretion of the departments to fund the purchase of supplies, research, or continuing education.
For Neurology faculty members who wish to learn more about CSRP, please contact Carl Gold.
Cost-Conscious Attending Rounds Checklist
Cost-Conscious Attending Rounds Checklist
This project focused on providing appropriate care to hospitalized neurology patients by reducing low-value practices, like unnecessary telemetry, recurring labs, and administering IV medications in patients who can take pills. The main intervention was a rounding checklist completed for every patient every day on the Neurohospitalist and Stroke services. Led by Drs. Carl Gold, Katie Kvam, and Neil Schwartz, this project involved getting engagement from ten faculty members, all of the neurology residents, and dozens of rotating interns and medical students. The cost savings have been considerable, care has been more appropriate, and the checklist has been used daily since its implementation in 2017. This was Neurology’s first CSRP project.
Grand Rounds in High-Value Care
Some of the cost savings from the “Cost-conscious attending rounds checklist” have been applied towards an honorarium for an annual Neurology Grand Rounds presentation from a national leader in high-value care. The first speaker in this series was Dr. Christopher Moriates in February 2020. Dr. Moriates is the Assistant Dean for Health Care Value at the University of Texas at Austin Medical School and the Executive Director of Costs of Care. Dr. Arnold Milstein, Director of the Stanford Clinical Excellence Research Center, delivered the second annual grand rounds on April 9, 2021.
Advancing Care for Patients with Intracerebral Hemorrhage
Clinicians in the neurocritical care unit recognized that some patients with intracerebral hemorrhage remain in the ICU due to intravenous antihypertensive medications. Drs. Zachary Threlkeld and Karen Hirsch designed a protocol for safe, earlier transition to oral antihypertensives. This has allowed many patients to leave the ICU earlier, advancing the timeline of their recovery. The reduction in ICU length of stay is associated with cost savings. This was Neurology’s second CSRP project.