February 04, 2020
Commercial payers spent more than $5.5 billion on 20 select low-value health care services in 2015, according to a new study from the Research Consortium for Healthcare Value Assessment, a collaboration between Altarum and VBID Health. We found that the prevalence of low-value care was widespread, with some regional variance, as illustrated on the map below. To reduce it, we need to take a closer look at where it is occurring and why.
State Frequency of Low-Value Care Services, Privately Insured, 2015
Although some states (Alaska, North Dakota, Utah, Idaho, and Oregon) performed better than others, none fell below 10 percent of members receiving at least one low-value care service. The worst performing states (Florida, New Jersey, North Carolina, New York, and Alabama) were twice that, with rates exceeding 20 percent of members. And while the study data was limited to the prevalence of low-value care among the privately-insured, prior research suggests that these findings are likely replicated among the publicly-insured, with some proposing that low-value services are even more common among vulnerable populations.
If the provision of low-value care is widespread and present regardless of payer type or anticipated reimbursement—what is driving it and how can we curb its use? Clues may be found on closer examination of the three most often-occurring services:
There is no single driver of low-value care—providers, systems, and patients all play a role. To reduce it, our solutions must align incentives appropriately along all three of these areas. Quality improvement CME training could help providers decrease the frequency of Pap tests to align with recommended guidelines. Improved interoperability and clinical decision support applications could help end blanket ordering of unnecessary panels through EHRs. And patient education and improved insurance plan design could help reduce patient preference for brand-name medications. The good news is that we know how to break down where low-value care is occurring and can begin to take a closer look at designing the correct interventions.
Read the full report.
Director, Healthcare Value HubAreas of Expertise
Beth is the Director of the Healthcare Value Hub and a Senior Analyst in the Applied Research and Analytics practice area at Altarum. Expert in both quantitative and qualitative health-related research projects, Beth brings extensive experience conducting literature reviews; numerous hours conducting key informant interviews for both focus groups and one-on-one interviews; and high proficiency in analyzing qualitative data. Her qualitative work includes topic areas such as defining and measuring low-value care; defining safety-net hospitals; and the practicality of low-value care tools to visualize waste within health care systems. Beth leads survey development, fielding, and analysis of quantitative data for the Consumer Healthcare Experience State Survey (CHESS), which advocates utilize to inform key decision-makers on out-of-network billing practices, surprise billing prevalence, and other affordability issues in their respective states. Beth also manages the Research Consortium for Health Care Value Assessment. She holds a doctor of philosophy degree in public affairs and administration from Western Michigan University.