Dr Kenneth Cohen: Change in Reimbursement Model Required to Reduce Low-Value Care

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Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare, describes the main challenges to identifying, measuring, and reducing use of low-value care and the granular data needed to solve these challenges.

Granular data at the level of a health system all the way down to the individual physician are required to improve low-value care measures, said Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare

Transcript:

What are the main challenges to identifying, measuring, and reducing the use of low-value care?

Low-value care is fairly easy to identify and measure. The care can either be in administrative waste—things like billing collection, prior authorization—but more importantly, it's in care delivery. It's care that doesn't improve health outcomes and care that doesn't improve quality of life. So at it’s best, it's wasted, and very often it's harmful. Reducing it, though, is the challenge, and that's the hardest part. To reduce low-value care, I believe, requires a change in our reimbursement model. As long as we continue fee-for-service reimbursement, the incentives will not be aligned to reduce low-value and wasted care.

What data needs to be collected for this?

I think most importantly, the data that is required for improvement in low-value care measures is granular data at the level of a health system, and then a physician group, and then a physician practice, and all the way down to the individual physician. And importantly, I think the data needs to be transparent. It has to be shared with a physician, with their colleagues. They have to have metrics that are comparable across states and across the US. And once we get to the point where everybody is comfortable transparently sharing granular data, that is a very potent change agent and it begins to drive care transformation.