Voices in Health Care Value

September 2018

Welcome to the inaugural issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment. This issue introduces the consortium and provides information about activities of others working in the area of value in health care. We would appreciate your comments and inputs to subsequent issues. If you are interested in becoming a Colleague in Value (individuals and groups who work in this area or who are simply interested in its findings) please register here.

LEAD ARTICLE

Optimizing Health Care Resource Allocation for Value & Affordability: The Research Consortium for Health Care Value Assessment

Traditional approaches to reducing health care spending often involve eroding coverage for care indiscriminately and fail to take a holistic perspective on all sources of costs and value. We believe that affordability in health care delivery is best achieved by efficiently allocating costs across the entire budget and spectrum of care. The proper framework is to move from how much we spend to how well it is spent. Inefficient spending not only drives up costs, but can negatively impact patient outcomes and consumes resources that could be redirected towards both underutilized routine care (e.g., colonoscopies, lifestyle counseling by primary care providers, and vaccinations), and underutilized innovative care that offers higher value (e.g., Hepatitis C drugs). A more efficient allocation creates the “headroom” for additional spending on high-value services. Continue reading here…

RESEARCH CORNER – In Case You Missed It

A description of the framework described in the lead article of this issue entitled “A Framework for Measuring Low-Value Care” was published in Value in Health and can be found here.

In an article by Margo Sanger-Katz, she argues that the answer to reining in health care spending may be small tweaks rather than big changes. Read the full article here.

In a series of papers by various authors, the February 2018 issue of Health Services Research examined understanding and improving value. Papers can be found here. While in the April 2018 issue of Health Services Research, several authors contributed work in the area of health care value. Papers can be found here.

Research from Andrew Heekin and colleagues examine the use of real-time clinical decision support interventions as a method to encourage and improve adoption of Choosing Wisely guidelines as well as other evidence-based guidelines. “Choosing Wisely Clinical Decision Support Adherence and Associated Inpatient Outcomes” is published in the American Journal of Managed Care. The article can be found here.

Michael Budros and Dr. Mark Fendrick introduce important considerations to reducing unnecessary services in their article “Levers to Reduce Use of Unnecessary Services: Creating Needed Headroom to Enhance Spending on Evidence-Based Care”, which was published in the American Journal of Managed Care and can be found here.

John Mafi and Michael Parchman offer a look into why fixing low-value care is so difficult in this editorial: “Low-Value Care: An Intractable Global Program With No Quick Fix”, which was published in BMJ Quality & Safety and can be found here

Research by John Mafi and colleagues indicates that, among low-value services, those that were low and very low cost occurred much more frequently than those that were high or very high cost. The article “Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending”, published in Health Affairs, can be found here.

THE COMMUNITY – A Spotlight Feature on a Colleague in Value

Each issue we will spotlight work by a Colleague in Value. This issue’s spotlight is on the Task Force on Low-Value Care housed at VBID Health. Michael Budros and Mark Fendrick provided the information in this article.

Task Force on Low-Value Care, VBID Health

The US spends more on health care per capita than any other country but does not achieve outcomes commensurate with that spending. A substantial share of this spending is devoted to services that buy no additional health, and in some instances, expose patients to serious harm. Experts estimate that between $158 and $226 billion is spent on low-value care every year (2011 dollars). Private payers bear the cost of between $90 and $140 billion of this amount. And there is reason to believe even the upper estimates of low-value care are too conservative. Beyond the heavy price that public and private purchasers pay, low-value services harm patients.

The Task Force was created to accelerate concerted action to reduce low-value medical care and thereby reduce pressure on payers and consumers. By drawing attention to research on low-value medical care, disseminating effective and practical tools, and identifying strategies for state and federal policymakers, the Task Force will help payers and purchasers "move the needle" on low-value care faster than they otherwise might.

Accordingly, the Task Force has since developed a “Top Five” list of services that should not be purchased at any price. Selected after carefully considering the potential for harm, cost, prevalence, and the availability of levers for purchasers to help reduce their delivery, the services are:

  • Diagnostic testing and imaging for low-risk patients prior to low-risk surgery;
  • Population-based vitamin D screening;
  • Prostate-specific antigen (PSA) screening in men ages 75 and older;
  • Imaging for acute low-back pain for the first six weeks after onset, unless clinical warning signs are present (red flags);
  • Use of more expensive branded drugs when generics with identical active ingredients are available.

Learn more about the Task Force on Low-Value Care and the levers available to reduce low-value care.

POLICY TO ACTION

These organizations engage in the process of identifying and finding ways to reduce the use of low-value care services in their target areas. For more information on these organizations and some of their findings please follow the links below:

  • The Washington Health Alliance in their report, First, Do No Harm: Calculating Health Care Waste in Washington State.
  • The Virginia Center for Health Innovation and the 2018 Virginia Health Value Dashboard, designed to promote better understanding of how Virginia performs in terms of delivering health value.
  • The Altarum Healthcare Value Hub with a focus on patient-centered, high-value health care that focuses on addressing inequities, high costs, poor coordination, and other problems. The Healthcare Value Hub reviews evidence to identify the policies and practices that work best.

UPCOMING EVENTS

From the Healthcare Value Hub at Altarum, “Pay for Success and SIPPRA: A Model for Investing in Social Determinants of Health.” An overview of Pay for Success and details of how this tool has been used to advance policy initiatives will be the focus of this Oct. 26, 2018 webinar. Register here.

PAST EVENTS

The purpose of the RC-HCVA symposium is to bring together our Colleagues in Value to discuss relevant research areas, challenges to implementation, and gaps in what end-users need to inform policy change regarding value in health care. The symposium is an invitation only event held annually. The 2018 Symposium Report can be found here. If you are interested in attending, please send an email to beth.beaudin-seiler@altarum.org.

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