Voices in Health Care - December 2018

December 2018

Welcome to the second issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment (RC-HCVA). This issue highlights the need for standardized reporting on low-value care and presents work from our colleagues at the Center for Health & Research Transformation. We 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

The Case for Low-Value Care Identification and Measurement at the State Level

By Michael Budros and Mark Fendrick, MD—VBID Health

A forthcoming article by the RC-HCVA team discusses the need for standardized identification and measurement of low-value care (LVC). Our team summarizes this need and the work we have begun to develop a standardized report at a state level.

States are uniquely positioned to identify, measure, and reduce low-hanging LVC

Better engaging stakeholders to more accurately measure the magnitude of LVC will substantially advance systematic efforts to reduce and eventually eliminate such waste. Although LVC can lead to harm and waste, there is significant headwind at the national level to reduce care of any kind. Accurate measurement and stakeholder champions armed with data can focus attention and direct action. We believe that states are a promising source of leadership and innovation on LVC.

An analysis performed by the Washington Health Alliance in 2018, using the Milliman Health Waste Calculator¹to identify low-value use of 44 specific services, reported that nearly one half of individuals received at least one wasteful service leading to an estimated $282 million in wasteful spending.² Virginia ran the Calculator on its all-payer claims database (APCD) and found that these 44 services, which only represent a small portion of total LVC, were delivered 1.7 million times in 2014 at a cost of $586 million (~2% of healthcare spending in Virginia).³ The associated Health Affairs article emphasized that the majority of LVC spending was on low-cost services, rather than high-cost and highly visible services. Specifically, over $20 million was expended on low-value vitamin D screenings in 2014.⁴

All-payer claims data in combination with tools like the Health Waste Calculator provide states with powerful information to take action. The power of this information will be enhanced with an ability to display LVC measures using a standardized scorecard in a compelling manner, which is currently under development by the RC-HCVA.

A lack of broad-scale identification and measurement around LVC remains a barrier to widespread change. The de-implementation (“exnovation”) of commonly used services that no longer have supporting evidence can be slow, but we hope that combining available tools and data to identify and measure the magnitude of LVC services at the state level will spur action.

Look for the full article to be released January, 2019.

Notes

1. Introducing the Health waste Calculator. VBID Health website. Accessed Nov. 28, 2018.

2. Highlights from: “First, Do No Harm,” Washington Health Alliance Website. Published Feb. 7, 2018. Accessed Dec. 17, 2018.

3. Mafi, John, Kyle Russell, Beth Bortz, Marcos Dachary, William Hazel, and Mark Fendrick, “Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending,” Health Affairs(October 2017).

4. Ibid.

RESEARCH CORNER – In Case You Missed It

The Health Care Transformation Task Force recently announced that its provider and payer members had nearly half of their business in value-based payment arrangements. Read full article here.
In a JAMA research letter, Dr. Kevin Platt and colleagues discuss their study on the overuse of self-monitored glucose testing in Type 2 diabetic patients, and the cost it has on the health care system. Read the full article here.
In a study by Aaron Schwartz and colleagues, they conclude physician practices may substantially contribute to low-value service usage but it is difficult to know which physicians are more wasteful without measuring their behavior. Read the full article here.
In a meta-analysis conducted by Dr. Daniel Morgan and colleagues to understand medical overuse, they found many current practices represent overuse while other services were used inappropriately. Read the full article here.
In an interview with the Patient Safety Network’s Perspectives on Safety, Dr. David Meltzer discusses his research in the Comprehensive Care Physician Model that he developed and has been testing to improve the cost and quality of hospital care. The full interview can be read, and listened to here.
An article by Anupam Jena and colleagues in the American Journal of Managed Care, examines value frameworks with real-world patient outcomes. Read the full article here.
The Health Affairs Council on Health Care Spending and Value announces the twenty member experts and charge of the group. Read the full article here.
In an opinion piece, Drs. Navathe, Emanuel and Volpp discuss the potential disconnect between patients and health care organizations/providers in value-based insurance designs. Read the full article here.
In a Health Affairs viewpoint article, John O’Shea discusses how the well intentioned efforts to move the health care system to be more effective is adding substantial administrative and regulatory burden on physicians, hospitals and providers. Read the full article here.
In this invited commentary, Dr. Peter Groeneveld discusses the nuances in measuring and improving value in health care. Read the full article here.
In an NBER working paper, Liran Einav, Amy Finkelstein, and Neale Mahoney identify a specific source of waste in long-term care hospitals. Read the full article here.
On July 12, 2018, the Altarum Center for Value in Health Care sponsored its 8^th annual symposium, Sustainable U.S. Health Spending: Serious Issues – Sound Policy Solutions. The full monograph featuring nationally-known health policy experts can be found here.

THE COMMUNITY – A Spotlight Feature on a Colleague in Value

Each issue will spotlight work by a Colleague in Value. This issue’s spotlight is on the Center for Health and Research Transformation (CHRT). CHRT’s Erin Spanier provided this information.

The Center for Health & Research Transformation (CHRT)

The Center for Health and Research Transformation (CHRT) is a non-profit impact organization, housed at the University of Michigan, which works to improve the health of people and communities, access to care, and evidence-based health care delivery. CHRT does this by contributing to the body of health services research that policymakers rely on (CHRT publications); by supporting community-based demonstration projects to identify ways to improve health and health care (CHRT demonstration impact); by broadly disseminating timely research and insightful analyses (CHRT policy impact); and by helping health researchers become more effective at conveying their research findings to policymakers and the press (CHRT policy fellowship). Learn about signature CHRT activities including the Cover Michigan Survey, Michigan Physician Survey, CHRT Policy Fellowship, and more at www.chrt.org.

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 Costs of Care – There mission and vision is to provide better care, better Health and lower cost. They contend that by working together we can improve the safety, affordability and experience of healthcare.
The Center for Health & Research Transformation - The Center for Health and Research Transformation (CHRT) is a non-profit impact organization. As described in the spotlight above, CHRT works to transform data and research into useful information that improves the health of people and communities.
Healthcare Transformation Task Force - The Health Care Transformation Task Force was established in 2014 with the goal of bringing together patients, payers, providers, and purchaser representatives to act as a private sector driver, coordinator, and facilitator of delivery system transformation.

UPCOMING EVENTS

Healthcare Value Hub, A Spotlight on the Virginia Center for Health Innovation, January 11, 2019. More information can be found here.
Abstracts for the Academy Health 2019 Annual Research Meeting are due Jan. 8, 2019. More information can be found here.
The AcademyHealth National Health Policy Conference in February 4-5, 2019 in Washington DC. More information can be found 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 2018 Symposium Report can be found here. More information on the 2019 Symposium event will be available shortly after January, 2019. If you are interested in attending, please send an email to beth.beaudin-seiler@altarum.org.