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V-BID Summit

The Challenge of Addressing Low-Value Care Once It's Identified

Laura Joszt
Panelists discussed low-value care, unnecessary services, and what can be done to address overuse in healthcare during a panel at the University of Michigan Center for Value-Based Insurance Design’s (V-BID) annual V-BID Summit on March 14.
 
From the employer perspective, Vela explained that there may be need to take actions once these services are identified. Employers need to know how to measure the low-value care being provided in their population, or they won’t know if the endeavor is worthwhile to undertake. But ultimately, employers and health plans have to encourage physicians to stop ordering the services and tests that are identified as low value.

“What can the employer do to impact, at the end of the day, so the physicians have the information, the authority, and the incentive to do the right thing?” Vela asked.

The panel also discussed the top 5 low-value care services identified by the Task Force on Low-Value Care:
  • Avoid unneeded diagnostic testing and imaging for low-risk patients before low-risk surgery
  • Avoid vitamin D screening tests
  • Avoid prostate-specific antigen screening in men 75 and older
  • Avoid imaging for acute low-back pain for the first 6 weeks after onset, unless clinical warning signs (“red flags”) are present
  • Avoid use of more expensive branded drugs when generics with identical active ingredients are available
Employers seem to believe that as the industry moves toward alternative payment models, some of these top 5 services will be taken care of.

“At the end of the day, it’s really, really tough to stop physicians from doing all these things…but, at the end of the day, if we have accountable providers who understand their accountability and can measure their accountability, then, in fact, this would be the great stuff for them to get rid of,” Vela said. “It’s the low-value care they want to get rid of.”

Bortz had been part of the task force that came up with the top 5, and since Virginia had so much data and access to an All-Payer Claims Database, the state’s data was used as a reference point to help provide a sense of scale. When choosing the 5, the task force knew it didn’t want to pick something right out of the gate that would prove controversial and possibly turn some people off the idea immediately. However, they wanted to ensure they picked at least 1 or 2 that were meaningful and could have a financial impact.

ABIM Foundation had created its own “dirty dozen” list that included 3 of the top 5 from the task force. Wolfson views these lists as a signal to the community that employers and purchasers are thinking about the issue and “are not going to tolerate low-value care.”

“We have well-intentioned people doing things routinely because that’s how it’s been done,” Wolfson said. “You’ve got to get their attention.”

However, since the Choosing Wisely campaign took off in 2012, there has been only some movement in the use of identified unnecessary tests and procedures. Wolfson explains that nothing happens without and intervention, and even then it takes time.

“We talked about underuse for 30 years,” he said, and admitted that he was part of that conversation. Shifting in the other direction to prevent overuse will take time, he said. “I’m very humbled about what it’s going to take to stop people from doing things they’ve been doing for a long period of time.”
 

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Dr Robert Dubois Explains Challenges in Addressing Low-Value Services
 
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