In a recent article, Harvard University professor Michael E. Porter and Press Ganey CMO Thomas Lee outline a six-point strategy to improve healthcare value ("The Strategy that Will Fix Health Care," Harvard Business Review, October 2013). Although they offer several excellent ideas, their argument fails to address the epidemic of overuse.

Incorporating Patient Preferences

Porter and Lee emphasize that healthcare systems must focus on outcomes and cost but they fail to describe a fundamental criterion for health services excellence: that patients receive only the care they want and need. Numerous studies indicate that patients are not adequately informed about the services they receive and that--if they were--they would not necessarily choose to receive them. If providers do not consider patients' wants and needs, the services they provide may appear to create value by virtue of having a low cost and good outcome (in that the goals of the intervention are achieved); however, we would argue that such service provision typifies waste and exposes the patient to unnecessary risk.

Use of decision aids that clearly outline the risks and benefits of medical interventions and help patients make choices consistent with their values can substantially reduce the demand for healthcare interventions. Measurement of decision quality that captures patients' understanding of...