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Identifying the Top 5 Low-Value Services That Can Be Targeted for Reduction

Since its inception in 2005, the University of Michigan Center for Value-Based Insurance Design (V-BID) has led efforts to promote the development, implementation, and evaluation of innovative health benefit designs balancing cost and quality. A multidisciplinary team of faculty, including A. Mark Fendrick, MD and Michael E. Chernew, PhD, who first published and named the VBID concept, have guided this approach from early principles to widespread adoption in the private and public sectors. The Center has played a key role in the inclusion of VBID in national healthcare reform legislation, as well as in numerous state initiatives. The basic VBID premise is to align patients' out-of-pocket costs, such as copayments, with the value obtained from health services and providers.
This article was collaboratively written by A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design (V-BID), and several V-BID Center staff. 

As the future of the American healthcare system is debated in legislative chambers, classrooms, and living rooms across the country, one thing that almost everyone agrees upon is the need to cut costs while maintaining, or ideally improving, the quality of healthcare delivery.

The United States spends significantly more on healthcare, both per capita and as a percentage of the gross domestic product, than any other developed nation, yet fails to achieve commensurate health outcomes.One reason for this discrepancy between health spending and outcomes is the large amount—upwards of $200 billion a year according to experts—that the United States spends on low-value care that provides no additional health benefit and, in some instances, may even be harmful to patients.2

Though the substantial contribution that low-value care makes to US healthcare expenditures is not a new revelation, previous efforts to identify, quantify, and reduce the use of low-value clinical services have been met with challenges. Campaigns such as the Choosing Wisely initiative have called upon healthcare providers to identify low-value services, but without corresponding action by purchasers and other stakeholders, progress has been slow.

Building upon the lessons of the Choosing Wisely initiative, VBID Health’s Task Force on Low-Value Care has identified a top 5 list of low-value clinical services for purchasers to target for reduction. The selected services were chosen based on their association with harm, their cost, their prevalence, and the availability of concrete methods to reduce their use.3 The appears as:
  1. Unnecessary diagnostic testing and imaging for low-risk patients before low-risk surgery
  2. Vitamin D screening tests
  3. Prostate-specific antigen (PSA) screening in men age 75 and older
  4. Imaging for acute low-back pain within 6 weeks of onset, unless clinical warning signs are present
  5. Use of more expensive branded drugs when generics with identical active ingredients are available

These services—chosen with the tenants of clinical nuance in mind—offer little to no clinical value, expose patients to unnecessary harm, and collectively contribute to over $25 billion annually in wasteful health spending.3 In going beyond identification to also offer concrete ways in which purchasers can work to eliminate the top 5, this new VBID Health initiative has the potential to catalyze meaningful change in the treatment of low-value care. Whether through alternative payment models, network design, or coverage policies, it’s time to take action against the financial and health burden of low-value care.

To learn more, view the infographic below, read the Task Force on Low-Value Care’s press release, and visit the Low-Value Care initiative page on the V-BID Center website.

  1. “Health Spending.” Organisation for Economic Co-operation and Development. (2016).
  2. Berwick DM, Hackbarth AD. Eliminating Waste in US Health Care. JAMA. 2012;307(14):1513. doi:10.1001/jama.2012.362.

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