How Is US Progressing in Measuring, Reducing Low-Value Care?

Reducing low-value care means saving money, reducing potential harm, and creating room for high-value care to be delivered in the United States.

How is the United States advancing in its efforts to reduce low-value care?

To answer that question, a panel assembled by the Center for Value-Based Insurance Design (V-BID) at the University of Michigan for its 2022 V-BID Summit included a cardiologist, an executive from Arnold Ventures, and the executive director of the Washington Health Alliance to look at successful examples as well as the tools needed to measure progress.

With support from Arnold Ventures, the Washington Health Alliance has created the Low Back Pain Implementation Collaborative. Nancy Giunto, who heads the alliance, said the topic was chosen by 29 stakeholder organizations, including purchaser organizations, commercial insurance plans, large provider groups, others. The choice was driven by data, she said.

According to the organization, it is estimated that 80% of Americans will have some form of back pain in their lifetime, but few receive high-quality care to address it.

Giunto emphasized that the project also relies on breaking down silos and bringing people together for conversation about the issue.

“When you have a room full of health plan leaders and purchasing leaders, and providers, you know, we have around this table specialists in the state of Washington from many different systems, who know the direct care of back pain patients and know the challenges to it, nd when you have them talking to one another, candidly about what's not working in the system, there's some magic that we hope occurs,” she said.

In another project funded by Arnold, the University of California, San Francisco (UCSF), is partnering with state Medicaid managed care organizations to identify ways to reduce low-value care. The team is getting input from other practitioners, said Rita Redberg, MD, MS, professor of medicine, at UCSF.

Arnold Ventures, the well-known philanthropy that funds evidence-based research, is also working with organizations on policy development, technical assistance, and implementation support, said Erica Socker, PhD, vice president of the philantrhopy’s health care and payor reform section.

“One thing that's really top of our list right now is working on reforms to the financial incentives that are facing providers, we think it is essential to make progress on this issue to move away from the fee-for-service system and to move to alternative payment models,” she said.

“I think the promise of the accountable care organizations [ACOs] is that you can really get the high level kind of overarching incentives right, and make sure that you're not asking providers to work against their financial interests, which I just don't think is a realistic thing to do,” Socker said.

Another recent emphasis is on creating very specific measures of low-value care within certain specialties in order to drive health system change.

Is reducing low-value care creating room for more high-value care, asked the moderator, Clifford Goodman, PhD, senior vice president, comparative effectiveness research, The Lewin Group.

There is anecdotal evidence in the state of Washington, said Giunto; some employers are modifying programs to move in that direction. She also agreed with Socker that incentives have to be better aligned to encourage providers to provide high-value care.

As a physician, Redberg brought up another pitfall of low-value care—avoiding it isn’t only about cost; it is also about avoiding care that could potentially be harmful.

“The primary advantage is that you're avoiding care that isn't going to help someone and that can only harm them,” she said. "Because a lot of people, you know, even if the care was free, you don't want to get care that isn't likely to help you, because you're always at risk for the harms."

Socker touted physician-led ACOs in particular, noting that they are more successful than hospital-based ACOs due to how the incentives are structured.

“You're allowing a primary care doctor or a different physician to kind of benefit from that and receive some shared savings from that. And so that I think gives them an incentive, because they're not reducing their own revenue,” she said, adding that some resources might then be reallocated to providers who are administering a high-value service.

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