Voices in Health Care Value - April 2021

April 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 work from our colleagues at Altarum’s Center for Healthy Women. 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

High- and Low-Value Care for Women

By George Miller

Our featured Colleague in Value for this quarter is Altarum’s Center for Healthy Women (CHW). A summary of the center’s work appears later in this newsletter. Some of the center’s activities complement those of the Research Consortium for Health Care Value Assessment (RC-HCVA) that are aimed at identifying the occurrence of high- and low-value care, encouraging the use of the former, and discouraging the use of the latter.

Previous work by the RC-HCVA has included investigation of the prevalence of low-value care for women. For example, an analysis of 20 low-value clinical services for the U.S. commercially insured population in 2015 found that the most frequently occurring low-value service was unwarranted routine annual cervical cytology screening (Pap tests) in women aged 30-65. We estimated that a total of 7.1% of commercially insured women received this low-value service in 2015 at a cost of over $782 million. We hypothesized that this high frequency was a result of providers’ training and culture of practice not keeping pace with current best practices.

The CHW has developed a claims-based Maternity Care Measure that can be used to identify the prevalence of high- and low-value maternal care. Focusing on the Medicaid population, the measure tracks the services received by a maternity patient from the start of her prenatal care through delivery, postnatal care, and post-partum care, identifying key triggers (claims codes) representing services that must occur within a specific time window to be considered high value. With this measure, organizations can determine how often their maternal patients are following a high-value care plan and where in the plan there may be gaps in care. This analysis can then help the organization identify solutions that may increase high-value activities and reduce low-value activities in the maternal care plan.

While concern over high and low-value services for women goes well beyond maternity care, a high-value family planning strategy can provide substantial benefits to women patients. The CHW is involved in a study to integrate family planning for women who suffer from substance use disorder. This study will help these women prepare for their families in a way that will include high value maternal care that increases the possibility of having healthy babies.

We look forward to future efforts of the CHW to address value in women’s health care and the possibility of collaborative efforts between CHW and the RC-HCVA.

RESEARCH CORNER – In Case You Missed It

In this article published in JAMA Netw Open, John Mafi and colleagues examine trends in low-value health services for Medicare fee-for-service programs. They find that for Medicare fee-for-service beneficiaries there was a marginal decrease in the use and spending of 32 low-value care measure from 2014 to 2018. Read the full article here.
In this op-ed in The New York Times, Amy Finkelstein discusses why it is so hard to cut waste in health care. Read the full article here.
In this article published in Healthcare, Allison Oakes and colleagues explore the impact of global budget payment reform on systematic overuse in Maryland. Their findings suggest that global budgets alone may be too blunt of an instrument to selectively reduce low-value care. Read the full article here.
The Going Below the Surface initiative has developed roadmap on for addressing low-value care. Read full presentation here.
In this article published in JAMA Netw Open, Ishani Ganguli and colleagues examine the prevalence and cost of care cascades after routine testing during Medicare annual wellness visits. Their findings suggest there is evidence that healthy Medicare beneficiaries received low-value electrocardiograms and urinalyses associated with cascades of care after receiving routine tests during their annual wellness visits. Read the full article here.
In a recent concept paper published by The Research Consortium for Health Care Value Assessment, we discuss data barriers that impede our understanding of low-value and high-value care. Read full concept paper here.

THE COMMUNITY – A Spotlight Feature a Colleague in Value – Altarum’s Center for Healthy Women

Altarum has a long history of work in Maternal and Child Health (MCH). Our multi-disciplinary teams conduct assessments, inform development of performance measures, provide tailored interdisciplinary training and technical assistance, offer continuing education credits, create national research agendas, and conduct quantitative and qualitative analysis. In addition to maternal and child health, we bring expertise in family planning and reproductive health.

Our work is grounded in the socio-ecological model, which helps us pinpoint and address the key factors that contribute to poor health outcomes, health disparities, and inequities. Our research goes beyond describing a problem—we develop and implement systems-based solutions using a health equity lens to strengthen services for MCH populations, especially for those most marginalized in our society. Altarum’s insights are designed for practical application and achieving measurable results. More about Altarum’ work in MCH can be found here.

One particular project from the Center for Healthy Women at Altarum, focuses on the growing number of people with family planning needs and substance use disorders. This multi-faceted study uses an innovative cross-training model to bring together family planning and substance use disorder providers in the same geographical region and equip them with the skills and self-efficacy to effectively screen and refer their clients. There are opportunities to become involved in this study and you can find more information about this project at this link.