Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system

Ann Allergy Asthma Immunol. 2020 Aug;125(2):126-136. doi: 10.1016/j.anai.2020.04.007. Epub 2020 Apr 11.


Objective: To define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists.

Data sources: Articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening.

Study selections: A narrative review detailing concepts and approaches to improve value-based health care in the context of the Quadruple Aim to address the patient and physician experience, cost, and population health.

Results: Efforts to improve cost-effective care can be informed by understanding unwarranted geographic practice variation and benchmarking best practices. Although evidence suggests that shared decision-making and addressing social determinants of health have critical roles in high-quality care, some practices such as routine laboratory screening for urticaria, premedication to prevent recurrent low- or iso-osmolar contrast reactions, extended observation of resolved anaphylaxis, food allergy screening, and penicillin allergy overdiagnosis have high costs in relation to overall societal benefit. Food allergy prevention, newborn screening for severe combined immune deficiency, and penicillin delabeling are examples of population-based opportunities in which allergists and immunologists can assist in creating health care value. Although efforts to incentivize value-based care have emerged in recent years, the degree to which process measures improve patient-important outcomes remain uncertain. Clinician wellness must be made a priority for continued effective practice.

Conclusion: As health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Benchmarking / methods*
  • Cost-Benefit Analysis*
  • Delivery of Health Care*
  • Evidence-Based Practice
  • Health Care Costs
  • Humans
  • Hypersensitivity / epidemiology*
  • Hypersensitivity / therapy
  • Practice Patterns, Physicians'
  • Quality Improvement
  • United States / epidemiology