Voices in Health Care Value

December 2021

Welcome to the eleventh issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment (RC-HCVA). This issue features a re-cap of the 2021 accomplishments of the RC-HCVA as well as many of our Colleagues in Value, we hope you enjoy reflecting on these great pieces of work. 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.


Happy Holidays!

By Beth Beaudin-Seiler and George Miller

The end of 2021 is fast approaching, and there is no doubt that we continue to grapple with the impacts of a global pandemic. The progress towards normalcy has seemed to take a few detours as variants of COVID-19 have emerged. Shortages of nearly every type, most importantly human, can make it feel as though we are in no different of a space than we were a year ago. 

So, we want to take a moment to pause and reflect on the great work that has been accomplished this year. This issue of Voices in Health Care Value does not highlight any one Colleague in Value, instead it reflects on the collective work from all of us. It is our hope that in highlighting and reflecting on the accomplishments of 2021, we can move into 2022 with enthusiasm and optimism.

However it is you celebrate the various holidays this time of year, we hope that you, and those you love, are healthy and happy. From all of us at the Research Consortium for Health Care Value Assessment, we wish you a joyous holiday season.  

RESEARCH CORNER – In Case You Missed It

The Research Consortium for Health Care Value Assessment has been quite busy in 2021. We have published a number of research briefs and concept papers including:

Research Brief No 3: Similarities and Differences Between States with Varying Rates of Low-Value Care: A Qualitative Review. In which Allison Oakes provided a guest blog on this topic published in MedCity News. Read the research brief here and read Allison’s guest blog here.

Research Brief No 4: Do Investments in the Social Determinants of Health Reduce Health Care Costs? In this brief, George Miller and team discusses the correlation between investments in social determinants of health and the impact on health care costs. Findings suggest there is limited quality and consistency in the existing body of literature to determine impacts of these interventions on health care costs. Read the research brief here.

Research Brief No 5: Price Growth of Medicare Services After Elimination of Consumer Cost-Sharing. Mark Fendrick and team discuss the prices of Medicare Part B pre- and post-ACA implementation for selected preventive services. Findings dispel the premise that the elimination of consumer cost-sharing for medical services triggers a rapid and dramatic rise in prices. Read the research brief here.

Concept Paper No 9: Barriers to Our Understanding of Low-Value and High-Value Care. In this concept paper Beth Beaudin-Seiler and team discuss the approaches to measuring low-value care and the data sources needed to support each approach, as well as the challenges in obtaining that data. Read the concept paper here.

Concept Paper No 10: Advancing Health Equity by Increasing Access to High-Value Care. In this concept paper Ani Turner and Beth Beaudin-Seiler discuss the burden of low-value care in context of healthy equity and call for more focused attention on the impact of low-value on underserved and marginalized groups. Read the concept paper here.

The Research Consortium hosted another successful grant series for the second year in a row. This year’s theme was entitled Enhancing Health Care Value Through Data, Measurement and Evaluation of Services and Procedures. Seven awards were made to distinguished scholars, a webinar was hosted on November 3, 2021 and the papers are being published in a Health Affairs blog series from December through early January, 2022. The presentations and video of the webinar can be found here, and the link to the published papers can be found here.

Allison Oakes and Thomas Radomski, published a JAMA Viewpoint discussing the need to move away from fee-for-service medicine as a top-down payment reform strategy, but also include bottom-up initiatives to address behavioral drivers of low-value care. Read article here.

Brooks, Reyes and Chien argue in their publication in Health Affairs blog post, that it is time to set-aside the term low-value care and start focusing on high value care for everyone. This article discusses the role of systemic racism, discrimination and disparities for African American and Latinx communities and how the term low value care may be defeating the “cause it seeks to champion”. Read article here.

In this American Journal of Managed Care article, Howard Beckman, John Mafi and Beth Bortz discuss their practical 10 step program to reduce low-value care. Their findings suggest that the frequency of low-value care can be reduced with a program that focuses on respect, data, non-judgmental communication and explicit core values. Read article here.

Ishani Ganguli and colleagues discuss their research in a JAMA Intern Med article, Low-Value Care at the Actionable Level of Individual Health Systems. This work aimed to measure and report low-value care within and across health systems. Findings suggest that system level measurement and reporting of low-value care is feasible. Read article here.

In this article published in the J Gen Intern Med, David Kim and colleagues discuss the evidentiary rationale underlying recommendations against low-value interventions. They find that evidentiary rationale vary substantially, with most recommendations relying on clinical evidence. Read article here.

In this article authored by John Mafi and colleagues in JAMA Network Open, they discuss national trends in low-value care use and spending. Their cross-sectional study found that fee-for-service Medicare beneficiaries receiving any of the 32 measured services, low-value care use and spending decreased marginally. Read article here.

In this work by Prachi Sanghavi and colleagues in JAMA Internal Medicine, they discuss whether patients who receive more low-value care from their primary care professional rate their health experience more favorably. Their findings suggest that more exposure to low-value care services is not associated with more favorable patient ratings of their health experiences. Read article here.

In this JAMA Network Open article by Kelsey Chalmer and colleagues they discuss the hospital characteristics associated with overuse of health care services. They find the highest scores of overuse in the Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South. Read article here.

In January, 2021, Choosing Wisely, had a conversation with Mark Fendrick regarding his work on benefit design and lessons learned from Choosing Wisely called: Promoting High Value Care: A conversation with Mark Fendrick. Read article here.

In this JAMA Network Open article by Park and colleagues, they examine the difference in use of low-value care between traditional fee-for-service Medicare enrollees and those in Medicare Advantage from 2006 to 2015. Their findings suggest low-value care is prevalent in both groups and that managed care enrollment is not associated with decreased use of low-value care. Read article here.

Chalmers and colleagues discuss adverse events and hospital-acquired conditions associates with potential low-value care services in Medicare beneficiaries in this article published in JAMA Health Forum. Their findings suggest that patients receiving potential low-value care were exposed to unnecessary harms associated with higher cost and length of stay. Read article here.

In this article by Oronce and colleagues published in the Journal of General Internal Medicine, they examined the utilization and costs of seven USPSTF Grade D services among US Medicare beneficiaries. Findings suggest these services were frequently received by this group and could be an opportunity to safely reduce spending while improving care. Read article here.

Betsy Cliff and colleagues conduct a systematic review of Choosing Wisely interventions on low-value care in this article published in The Milbank Quarterly. They conclude that interventions built on Choosing Wisely recommendations can be effective in changing practice patterns when they are targeted at physicians and use more than one component. Read full article here.


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