EP505: The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD

Stacey Richter interviews neurosurgeon Dr. Ahilan Sivaganesan (Dr. Siva) about replacing vague healthcare "value" claims with quantified outcomes and unit-level costs, introducing his Operative Value Index (OVI). They discuss how hospitals often lack true internal episode costs and how common quality metrics miss patient-reported outcomes and appropriateness across the full care journey. 

Using time-driven activity-based costing (TDABC) and condition- or procedure-specific patient-reported outcomes, OVI creates a common mathematical language to compare surgeons, practices, or health systems, risk-adjust for confounders, and support steering/tiering and direct contracting for self-funded employers.  

Siva describes transparency via bubble charts that spur clinician behavior change without new incentives and argues this infrastructure is essential as bundled payments and risk-based arrangements expand, framing a "Yahoo vs Google" shift from fee-for-service volume to measurable value. 

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https://cc-lnk.com/EP505

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00:00 Introduction to this episode.

00:38 The goal of this episode.

01:28 What the Operative Value Index (OVI) is.

02:04 A quick episode overview.

04:23 EP434 with Benjamin Schwartz, MD, MBA.

04:44 How this episode came about.

09:24 How Dr. Siva got involved in the research around outcomes and costs.

11:51 How the value equation doesn't add up to true quality.

14:12 What measuring quality across the entire care journey means.

15:00 EP326 with Rishi Wadhera, MD, MPP.

15:08 EP295 with Rebecca Etz, PhD.

16:07 Why appropriateness is the foundation of quality.

19:08 Why practicing clinicians need to be thinking about the true costs of delivering care.

21:20 Time-driven activity-based costing (TDABC).

23:44 The two things that must be known for value-based care to succeed.

24:06 Article by Dana Prommel Strauss.

27:09 A quick summary of the conversation thus far.

30:42 The power of transparency in Dr. Siva's bubble plots.

32:39 EP449 with Marty Makary, MD, MPH.

34:05 Why these bubble plots work not just at the procedural level but at the diagnosis level, too.

36:13 EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky.

36:21 EP501 with Ivana Krajcinovic, PhD.

36:30 EP398 with Jacob Asher, MD.

37:28 The "big blue ocean" opportunity for forward-looking providers.

38:52 Substack post by John Lee, MD.

40:37 The incredible opportunity for entities and groups that can help provide the infrastructure needed for this value index.

41:42 Essay written by Dr. Siva.

43:19 Last thoughts by Dr. Siva on TDABC and competition on value.