Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare, discusses evidence-based education and other tools to address low-value care.
The use of evidence-based medicine as the clinical decision tool to make care decisions has the ability to diminish low-value care, said Kenneth Cohen, MD, FACP, executive director of clinical research at UnitedHealth Group Research and Development and senior national medical director at OptumCare.
What are the tools we can use to address low-value care?
To address low-value care, you need a broad set of tools. I think it begins with an educational foundation focused on evidence based medicine. It then needs to move to data that is available at the point of care. This is probably easiest to do with simple point of care algorithms, and the goal of those algorithms is to have the patient and the provider, together, look at them so that the patient can begin to understand what are the real world outcomes of the care choices they make. And the provider can actually help guide the patient to make the choice that most aligns with their values and preferences. Then, on the back end, we need to collect patient reported outcomes so that we can see what the real world outcomes are of the procedures that we're doing. And then finally, we need data and analytics so that we can actually look at what those outcomes are, provider by provider, and begin to transparently measure and share results, really to get rid of low-value care.
What is the purpose of evidence-based education, and how can it be utilized to reduce low-value care in the clinic?
What's fascinating is that, if you look at our guidelines, only about 80%, 85% of those guidelines are based on what are called consensus recommendations. And only about 10% to 15% is based on what is known as level 1 and level 1 evidence—those are hard, large, randomized control trials or large meta analyses. Because so much of what we do is based on consensus and not on hard data. I think there needs to be a renewed focus on driving evidence-based medicine as the clinical decision tool that we use to make a lot of our care decisions. By using that high quality evidence, I believe that low-value care will be diminished.