Eliminating low-value services to achieve a high-value system

Value. It’s a subjective term in and of itself. Valuable to whom? In relation to what? While definitions vary, one thing the health care industry can agree on is that reducing wasteful spending is essential to improving the U.S. health care system — especially spending on treatments that put patients at unnecessary risk. That’s a move I consider valuable: one that lowers cost and improves patient care.

Researchers from OptumLabs® looked at data from 2009 to 2014 to understand what impact the Choosing Wisely® campaign has had on the use of low-value services among patients over 50 with commercial insurance, and those over 65 with Medicare Advantage. Choosing Wisely aims to help doctors and patients choose care that is evidence-based, necessary and not harmful or duplicative. The program offers educational resources covering hundreds of tests and procedures, ultimately promoting better conversations between patients and their caregivers as they jointly determine which care options are best to pursue.

The results — though varied by type of care — are promising. According to its analysis, the Choosing Wisely program led to an overall decline in patients’ usage of services that create additional health risks, drive high cost, generate unpleasant side effects and, in some instances, lead to unnecessary or unsafe follow-up services.

The experts at OptumLabs offered several recommendations to continue the effort, phasing more low-value services out of the system. One stood out to me, showing where data and analytics play a role. They suggested using bundled payment models, which pay health care providers for a defined episode of care rather than each individual service. It made me think of some work Optum® recently completed with a client. Cleveland Clinic leveraged Optum analytic platforms and advisory services to define new “bundles” that led to a 7 percent to 10 percent savings range. Cleveland Clinic recognizes that not every disease state should be bundled, but it is advancing its bundled payment strategy where feasible.

Cleveland Clinic and Choosing Wisely are doing a great job of pairing data with expertise to improve patient care and lower costs across the system. Read more about the low-value services study to dive deeper into one way that data and analytics can help tackle a well-known barrier to value-based care.


About the author:

Steve Griffiths Headshot

Steve Griffiths, PhD, MS
Senior Vice President, Chief Operating Officer
Optum Enterprise Analytics

Steve Griffiths has more than 20 years’ experience in health analytics management, and currently heads up the Optum Enterprise Analytics organization. His main focus is driving growth and innovation through Optum products and services. Steve has a master’s degree in biostatistics from the University of Washington and a PhD in health services research, policy and administration from the University of Minnesota.

2 thoughts on “Eliminating low-value services to achieve a high-value system

  1. I do love the “choosing wisely” campaign. Its a good first step, and much of these suggestions made are perfect for stand only, trivial cost social media campaigns – especially is social media is seen as a means to improve clinical outcome and reduce costs, rather than branding. (personally, i always thought that if we could tap into the energy of the “anti-vaxers” and morph it into the “anti -antibioticers” ( reducing inappropriate antibiotic use) we could both save money and reduce unnecessary exposure to risk to children).

    Regarding the concept, however,of minimizing “just to be safe” tests. Test costs are usually only a secondary or tertiary consideration. The bigger clinical issue is trading off the test risk to the patient. Example: CT for head injuy in a child. Consider radiation exposure of a head CT in a 2 year old, versus the risk of missing a catastrophic brain bleed. Knowing that only , say 1 in 200 CTs are going to be abnormal, does one expose 199 two- year olds to radiation to catch the 1 bleed, or does one take a third approach and admit all 200 for overnight observation? )

    Algorithms only go so far, and often with testing it isn’t about “just being safe’, but instead trading off the least harm to a large group versusthe greatest benefit to an individual patient.

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