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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.
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 Calculator1 to 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.
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).
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.
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 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 firstname.lastname@example.org.
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The Research Consortium for Health Care Value Assessment is a partnership between Altarum and VBID Health, with funding from the PhRMA Foundation as part of its Value Assessment Initiative, established to promote the pursuit of value in health care delivery in the U.S. Follow us at @ValueConsortium.