Sleep medicine providers must speak to other stakeholders using language that they understand.

Value-based sleep is a term I use to highlight the need for greater emphasis on health economic outcomes in our field and to increase opportunities for collaboration by focusing on the outcomes that matter most to our constituents and potential partners. This article presents several key tenets of value-based sleep, which I outlined in a recent presentation at World Sleep 2017, a congress held in October in Prague, Czech Republic.

Beauty is in the Eye of the Beholder

Unlike sleep medicine providers, most other stakeholders only appreciate sleep as means to an end. They value sleep to the extent that it will help them achieve their desired goals. For example, patients value sleep to the extent it increases their quality of life. Payers value sleep to the extent it reduces healthcare spend. Employers value sleep to the extent that it increases workplace productivity. And so on (see Table 1).

Table 1 Perspectives in Sleep

Table 1. Perspectives in Sleep Medicine. (Click on the table to make it bigger.)

Beyond these objectives, most stakeholders do not value sleep as an end in and of itself. So to provide and demonstrate value, sleep medicine specialists must understand clearly the values of these multiple constituents. (For powerful and practical tips to identify rapidly what your patients value about sleep—and to improve rapidly your patient-centered skills—read my recent article on purposeful listening in sleep medicine.)

Increased Focus on Economic Outcomes

All stakeholders want to reduce costs and minimize financial risk. For example, today’s patients are increasingly cost conscious and well-informed. Payers reduce healthcare spend through complex preauthorization processes. Employers shift costs to employees through high-deductible health plans/health savings accounts. As a result there is dramatic need to understand and demonstrate the economic return on investment for sleep medicine services.

Even though evidence supports the economic benefit of treating sleep disorders, there are important gaps in the scientific literature. More important, stakeholders and financial decision makers remain unconvinced regarding return on investment. Key scientific and practical questions include: Which patients? Which disorders? Which treatments? In what time horizon? To advance understanding of these and related health economic issues in sleep medicine, our group at the University of Maryland is currently examining the costs of untreated sleep disorders (such as insomnia and obstructive sleep apnea) and the cost-benefit of treating these conditions, including the impact on healthcare utilization.

Need for Value-based Lexicon

To date, sleep medicine discussion has focused almost entirely on medical outcomes, largely the apnea-hypopnea index (AHI). And of course, excepting sleep medicine specialists, no one cares about the AHI!

Although the AHI is an important measure of disease severity and treatment effectiveness, stakeholders care about what matters to them, not what matters to sleep specialists. Sleep medicine will grow in direct proportion to its ability to develop language that speaks directly to the needs and wants of our constituents and partners—in terms that matter to them. (For a helpful discussion on language and structure and effective patient-centered communication, see my recent article on framing.)

How to Maximize Your Value: 5 Recommendations for Sleep Specialists

  1. Clarify your objectives. Know thyself. What are your personal and organizational objectives? Where are you, career-wise? Where do you want to be in 2, 3, and 5 years?
  2. Know your customers’ wants. Like Parsifal searching for the Grail, you must ask: Whom does sleep serve? Listen to uncover the outcomes that matter to your constituents. Make these your endpoints.
  3. Develop customer-centric language. Develop scripts. Rehearse them.
  4. Understand trends in payments and technology. Is your region adopting bundled payments or paying more for improved outcomes? How might telemedicine or preauthorization for PAP impact your practice?
  5. Know your numbers. To negotiate with confidence, know your cost per patient, cost per test, cost per outcome, and lifetime value of patient.


In the modern healthcare climate of increasing costs on the one hand and limited resources on the other, sleep medicine


Emerson Wickwire, PhD

specialists need to define, demonstrate, and maximize the value of what we do. This will require absolute, intense focus on the outcomes that matter to diverse stakeholders—outcomes including quality of life, reduced healthcare spend, and improved workplace performance, just to name a few. To advance understanding and expand opportunities for collaboration, research and development efforts must include and impact these outcomes of interest. At the same time, sleep medicine specialists must describe the extant economic evidence base in language that highlights value and resonates with our constituents. The need for sleep medicine services has never been greater, and the future is bright. Adopt a value-based sleep approach and survive, thrive, and grow.

Emerson M. Wickwire, PhD, is Director of the Insomnia Program at the University of Maryland School of Medicine. His current research examines health economic aspects of sleep disorders and their treatments in medical and organizational settings. His applied endeavors seek to bring the benefits of healthy sleep to all. Wickwire is associate editor of the Journal of Clinical Sleep Medicine and a member of Sleep Review’s editorial advisory board.