Sure, I learned that smoking and tobacco use were bad for you. And I learned that there were more than 100 chemicals in cigarette smoke besides tar and nicotine. But here a few facts that we never learned, and if we did, they certainly weren’t emphasized.

We memorize lots of things in medical school. We don’t just memorize the 12 cranial nerves, but we learn their paths, the muscles they innervate, what those muscles do, etc. We memorize complex metabolic pathways, along with the enzymes and cofactors required for each step. We memorize all the muscles, nerves, arteries, and veins throughout the body (As a foreign medical student, I had to learn these in Spanish, too). And of course, we learned the leading causes of death in the world, and in the US.

To reverse or even slow down the unsustainable rise in health care costs in the U.S., there will have to be to substantial reform in medical education. No one is happy with the current system, except perhaps insurance companies, health systems, and the pharmaceutical industry. Least happy of all are patients--the consumers of health care--and their employers, both of whom are paying the bills.

As the movement away from fee-for-service towards value-based care marches on, hospitals and health systems will continue to be at greater and greater risk for payments. As patients, employers and insurers continue to bear the ever-increasing burden of rising healthcare costs, they will begin to demand better value for their financial outlay.

What is value and how is it measured? Fortunately, 8 years ago I was fortunate to attend the Value in Healthcare Course at Harvard Business School taught by Professors Michael Porter and Robert Kaplan. Simply put, value can be defined by the equation V = Q/C, where V=value, Q=quality and C=cost. Simple enough, right? Not really. Neither the numerator nor the denominator of the value equation can be easily determined.

Listen to my podcast with Relentless Health Value. In this episode, we discuss advice for health systems in the face of consumerism and value-based contracts