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, 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.