• Leah M Marcotte, Christopher Moriates, Daniel B Wolfson, and Richard M Frankel.
• L.M. Marcotte is associate medical director for population health, UW Medicine, and clinical assistant professor, Department of Medicine, University of Washington School of Medicine, Seattle, Washington. C. Moriates is assistant dean for health care value, Department of Medical Education, associate chair for quality, safety and value, and associate professor of internal medicine, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas. D.B. Wolfson is executive vice president and chief operating officer, American Board of Internal Medicine (ABIM) Foundation, Philadelphia, Pennsylvania. R.M. Frankel is professor of medicine and geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
• Acad Med. 2020 Jun 1; 95 (6): 864-867.

Abstract"High-value care" has become a popular mantra and a call to action among health system leaders, policymakers, and educators who are advocating widespread practice changes to reduce costs, minimize overuse, and optimize outcomes in the United States. Regrettably, current research does not demonstrate significant progress in improving high-value care. Many investigators have looked to payment models, benefit design, and policy changes as the main levers to reduce low-value care delivery; thus, the prevailing approach to ensuring high-value care has been to identify and limit low-value services. This approach has a clear limitation: The number of identified low-value services has become too high for individual physicians to track. Using professionalism as a key driver of practice change presents an important opportunity to shift from a deficit-based reactive model to one that is proactive and uses the concepts of intrinsic motivation and medical stewardship to effect high-value care. Transforming aspirational values such as professionalism into actions that engage all physician stakeholders regardless of their position or influence, and regardless of system agility or payment structure, has the potential for bringing about real change. These concepts can be integrated into medical education, introduced early in training, and modeled by educators to drive long-term sustainable change. Physicians can, and should, embrace professionalism as the motivation for redesigning care. Payment reform incentives that align with their professional values should follow and encourage these efforts; that is, payment reform should not be the impetus for redesigning care.

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