Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare, explains why low-value care still exists and how the COVID-19 pandemic has affected the issue.
The COVID-19 pandemic allowed experts to get a "bird's eye view" of how the US health care system may function with a lower intensity of care, said Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare.
Why does the use of low-value care persist despite the knowledge that it can cause harm, incur unnecessary costs, and waste health care resources?
Low-value care, I don't believe is going to disappear until there's fundamental reform of our reimbursement model, and I've mentioned this before. There are perverse incentives in our current model that encourage the use of low-value care. And when physicians are responsible for the care of an entire population, as opposed to being reimbursed for exactly the services that they deliver, they begin to look at care differently. And that's when they begin to think about what's best for a patient and a population of patients. Once you begin to do that, then low-value care naturally tends to diminish.
While we remain in a pandemic, how is cutting out low-value care more important?
The [COVID-19] pandemic has had an interesting impact on the whole area of low-value care. The downside is that we know that catheterization labs, for example, saw 50% and 60% decreases in catheterization volume, which ostensibly was done for people having heart attacks. Why that decrease occurred is unknown because it wasn't matched by an increase in heart attacks that were seen that didn't receive care, so it was a bit of a mystery.
But what was most fascinating—and I think it's pertinent to the question—is that we know that, early on in the pandemic, office visits went down by 80% to 85%. Patient outcomes did not worsen by 80% to 85%, suggesting that a lot of the things that we do in our day-to-day office practice may not be necessary. It may be patients coming in for respiratory infections that would have gone away in 3 days. It may have been physicians requesting patients have follow up more frequently than is necessary and having patients come to the office when they don't need to. But it allowed us to really get a bird's eye view of what our health care system might look like with a lower intensity of care.