Perspective: Low-Value Care is Everywhere. What is Driving It and How Can We Intervene?

February 04, 2020

Beth Beaudin-Seiler

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

A map showing the state frequency of low-value care services among the privately-insured in 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. 

Low-Value Care is Everywhere. What is Driving It and How Can We Intervene?

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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:  

  1. Routine cervical cancer screen in women 30–65 ($782 million). It is unlikely that patient preference is driving a demand for annual Pap tests. A more likely culprit? Providers whose training that is out-of-step with current best practices. 
  2. Population-based screening for Vitamin D ($928 million). Here the blame may lay with electronic medical systems programmed to be more efficient through 1-click ordering, yet unintentionally perpetuating a low-value service in bundled laboratory panels. 
  3. Use of brand-name drugs over generic equivalents ($1.57 billion). In this case, patient preference may play a role, either through lack of education or financial incentives, for example, discounts and coupons offered for brand-name drugs.

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.  

Altarum is a nonprofit organization that works with federal and state agencies and foundations to design and implement solutions to improve the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We achieve measurable results by combining our expertise in public health and health care delivery with technology, workforce training and continuing education, applied research, and technical assistance. Our innovative solutions lead to better health for beneficiaries and better value for payers.
Low-Value Care is Everywhere. What is Driving It and How Can We Intervene?


Beth Beaudin-Seiler

Beth Beaudin-Seiler  - PhD

Director, Healthcare Value Hub

Areas of Expertise
  • Defining and Measuring Value in Health Care
  • Low-value Care
  • Consumer Affordability in Health Care

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.