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Reducing Low-Value Care May Mean Tough Conversations With Stakeholders

Laura Joszt
The concept of value is a well-known topic among health policy experts, the payer community, and policy makers, but patients do not necessarily have the same idea of what value means. When discussions about removing low-value care from the system to save money come up, patients might get the wrong idea of what is going on and why.
Reducing low-value care can free up money to be spent on high-value services, but it’s a delicate conversation to have, according to panelists at the University of Michigan Center for Value-Based Insurance Design (V-BID)’s V-BID Summit, held March 13 in Ann Arbor, Michigan.

The concept of value is a well-known topic among health policy experts, the payer community, and policy makers, but patients do not necessarily have the same idea of what value means, explained Daniel Carey, MD, secretary of health and human services for the Commonwealth of Virginia.

For instance, when the concept of value is introduced into a conversation around achieving access to care, some stakeholders might get the wrong idea, he said.

“For some, I found out in the last 6 or 8 months, that sounds like we’re trying to reduce access…trying to take something away,” Carey explained.

The language being used in these discussions is crucial, said Gwen Darien, executive vice president for patient advocacy and engagement at the National Patient Advocate Foundation (NPAF). Her organization represents approximately 150,000 patients who are primarily low-income, underresourced, and have trouble accessing quality, affordable, and equitable care.

Patients don’t think about the mathematical formula policy makers and other experts in the field are using to define value and remove services that are considered low-value because they might cause harm or be unnecessary. Instead, patients are concerned with a notion ingrained in American culture that if something is being taken away from them, then they’re being stinted.

The conversation has to make it clear that services are being taken away in order to keep patients safe from harm, she added.

“A lot of the ways that we’ve talked about reducing low-value services has had to do with waste and waste in the system,” Darien said. “People do not want to hear that anything that their doctor is prescribing for them is wasteful.”

That’s why explaining the harm of unnecessary or low-value services is important and can help the patient understand that the concern is keeping them safe.

“Less can often be more, because more can lead to unintended consequences,” she added.

When Cigna talks about reducing low-value services, many times people interpret that as taking away care, according to John Keats, MD, national medical director for affordability and specialty partnerships at Cigna. But the company tries to be very deliberate and uses evidence generated by other organizations and the recommendations of the United States Preventive Services Task Force (USPSTF) to make decisions on low-value care that can be removed. If USPSTF gives something a D rating, which means it is not recommended to be used in asymptomatic patients.



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