Voices in Health Care Value - June 2019

June 2019

Welcome to the fourth issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment (RC-HCVA). This issue highlights work from our colleagues at the Center for Enhanced Value Assessment (CEVA). 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:

Contrasting Spending Trends in Low- and High-Value Care

By George Miller—Altarum

The focus on identifying, measuring and reducing the prevalence of low-value care services has increased over the last several years, with researchers looking to quantify the level to which these services are occurring. Previous analyses in recent years have found that the use of these services remains frequent and also makes up a measurable portion of total spending. If spending on low-value care were reallocated to high-value services (services whose clinical benefits outweigh the risks and the costs), current U.S. health care spending, which is nearly 18% of our GDP, would not be as unpalatable as it currently is.

The Research Consortium for Health Care Value Assessment (RC-HCVA) has conducted a study that seeks to understand trends over time in frequently cited examples of low- and high-value care, to be used as indicators of spending trends in private insurance and to illustrate if progress has been made in eliminating low-value services and transitioning spending to higher-value care. Measurement of five low-value and five high-value services applied coding specifications to recommendations for reducing use of the low-value services and increasing the use of the high-value services. We estimated the total utilization and spending on each service in a commercial claims dataset from a single insurer, spanning from 2014 to 2016. Coding specifications for each low-value service include inclusion codes to ensure the service was used for the purpose described in the recommendation and exclusion codes to denote circumstances under which a potentially low-value service may have been warranted due to complicating factors.

Extrapolation to the entire US privately-insured population used the resulting rates of low-value and high-value care per member and applied Medicare prices that were inflated to an estimate of private prices. The study found that spending on the low-value services remained mostly flat from Q1 2014 through Q4 2016 (though this means the growth was lower than that of overall spending). Spending on the high-value services increased by 17%, which was less than the 22% increase in overall spending observed for the same period. However, there was significant variation in growth among the ten services. For the entire U.S. privately-insured population, spending was nearly $3.0 billion annually on only these five examples of low-value care. This suggests that little progress has been made toward increasing the value of health care spending in the U.S.

This work provides a framework, upon which we intend to build by incorporating more services and richer data, to discuss health care spending in terms of where we spend in addition to how much we spend and provides data on trends in high-value and low-value spending. The study report can be found here https://www.hcvalueassessment.org/publications

Additional information on this study can be found here:



  • An article in BMC Health Services Research by Allison Oaks and colleagues discusses systemic overuse in the commercially insured population. Findings suggest that systematic overuse is found at a regional level and stays persistent over time. Read full article here.
  • In an article in the American Economic Journal, Curto and colleagues compare health care spending in public and private Medicare using Medicare Advantage claims data. Findings indicate that Medicare Advantage insurers have revenue that is 30 percent higher than their total health care spending which is resulting in a difference in health care utilization. Read full article here.
  • In an article published by the American Journal of Managed Care, Ma and colleagues evaluate the impact of value-based insurance design (VBID) on total healthcare spending. Findings show that removing cost-sharing for primary care cut total spending by decreasing emergency department visits and related outpatient spending. Read full article here.
  • The American Journal of Managed Care published an article by Cliff and Federick that stresses the need for deliberate efforts to curtail the use of low-value services in order to improve primary care, promote healthier populations and establish more efficient spending. Read full article here.
  • A recent article published in PAIN discusses the need for system strengthening in order to support value-based care and healthy aging among populations with chronic pain. Read full article here.
  • In the Journal of Hospital Medicine, Borskey and Colleagues examine the effectiveness of the Agency for Healthcare Research and Quality’s (AHRQ) Evidence-Based Practice Center (EPC) Program in identifying and synthesizing evidence to inform evidence-based care. Using Clostridium Difficile Colitis prevention and treatment as a case study, researchers found that EPC programs are helping hospitals and healthcare systems to improve clinical care delivery and its derivative value. Access full article here.
  • In the American Journal of Managed Care, Jost highlights the importance of trust when employers are trying to implement successful healthcare programs and engage employees to change behavior. Efforts to improve access to care, affordability and health outcomes must be exercised through high-value care strategies, including value transformation programs integrated care management and value-based programs. Read full article here.
  • In an article published by Value in Health, Augustovski and colleagues address the need for value-based programs as a central foundation in policy-making and helping to create better-informed pricing in healthcare. Their argument lies in that better-informed pricing will lead to higher-value spending which can improve health outcomes, strengthen health system sustainability, and promote high-value innovation. Read full article here.

An article published in Value in Health by Franklin and Colleagues explores the awareness and perspectives of patients with cancer regarding the Quality-Adjusted Life Year (QALY), a measure of disease burden, including the quality and quantity of a life lived. While the QALY is often used to measure value in healthcare, participants showed minimal understanding of this tool with concern as to whether the QALY would help to inform decision-makers among policy-makers, payers and other healthcare stakeholders. Read full article 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 Health Care Transformation Task Force. The Task Force’s Clare Pierce-Wrobel provided this information.

The Health Care Transformation Task Force (HCTTF or Task Force)

The Health Care Transformation Task Force (HCTTF or Task Force) is a nonprofit industry consortium comprised of patients, payers, providers and purchaser organizations that support accelerating the pace of delivery system transformation to better pay for value over volume. Established in 2014, the Task Force provides opportunities for shared learnings among members and works closely with these leading innovators to develop educational resources to help their organizations and others embark on a successful journey to value transformation.

Task Force members participate in various work groups and use their market experience and expertise to help guide the development of resources that may provide other organizations with valuable insights to support the transition to value-based payment and care delivery models. The Task Force’s most recent releases include a Value Partnership Evaluation Toolkit, which was developed to support leaders as they assess potential partner organizations for readiness to engage in successful value-based partnerships; and a Consumer Engagement in Care Delivery Implementation Framework which includes a set of best practices that can be used to support the development of patient engagement initiatives. More information on the Task Force, including information about upcoming webinars, can be found at https://hcttf.org.



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