Offers opportunities to improve care, lower costs
Portland, Ore. – Today the Oregon Health Leadership Council and Oregon Health Authority released Better Health for Oregonians: Opportunities to Reduce Low-Value Care, a new report that seeks to lower the cost of health care by partnering with the medical community to identify low-value services.
The report defines low value care as medical treatments, tests and procedures that have been shown by the medical community, through evidence and research, to provide little benefit in specific clinical scenarios. Examples include opioids prescribed for lower back pain in the first four weeks, or imaging for uncomplicated headaches. It uses the Milliman MedInsight Health Waste Calculator, a software tool designed to analyze insurance claims data to identify and quantify low value health care services.
“We are excited to share this report with our colleagues,” said Jill Leake, director of clinical strategies for the Oregon Health Leadership Council. “It represents a true collaborative effort that was led by physicians and supported by Oregon Health Leadership Council and Oregon Health Authority. This information will help the health care community identify actionable opportunities to reduce low value care so we can work to stem the rise of health care costs and improve the effectiveness of care that is delivered to patients in Oregon.”
The report examined 47 measures over a three-year period (2016, 2017, 2018) for all lines of business (commercial, Medicaid and Medicare). Each measure evaluates a common treatment, test or procedure that is regularly used within the medical community. Findings showed widespread delivery of low value services across all measured populations.
“The COVID-19 pandemic has placed unprecedented strains on the health care system in Oregon and continues to impact the health of Oregonians in numerous direct and indirect ways,” said Dana Hargunani, MD, chief medical officer for the Oregon Health Authority. “As we continue to respond to this emergency and prepare for recovery, it is critically important that our health system focuses on delivering high value care when we need it the most. This report presents tangible opportunities that health care providers can tackle now, even during this difficult time.”
The measure with the greatest low value utilization was opioids prescribed for acute low-back pain during the first four weeks. There were 772,094 services found to be low value, representing 20% of all low value utilization evaluated.
Other key findings include:
- 40% of evaluated services were found to be low value (3.8 million services).
- $530 million was spent on low value care in 2016, 2017 and 2018.
- The top 15 most utilized services accounted for 97% of all low value services identified, affecting 2.9 million people, with $293 million spent. These measures represent a very good place to start when selecting targeted interventions to reduce low value care.
- The overall “low value index” (the percentage of total services that are considered low value) was highest in the commercially insured population at 49%, compared with 45% for Medicaid patients and 31% for Medicare patients.
- Medicare had the highest rate of low value services per 1,000 members, while Medicaid had the lowest rate.
- Medicare had the highest low value care per member per month (PMPM) at $8.74, which is more than twice that of the commercially insured population at $4.05. Medicaid’s low value PMPM is significantly lower at $1.87.
“We recognize that the provision of low value services is only one of several contributors to the continued increase in health care costs,” said Leake. “Our hope is that the information in this report serves as a catalyst for providers and health care leaders to advance positive change within their organizations and promote high value care for all Oregonians.”
Examples of how health care leaders can use the findings in the report include: creating patient, staff and provider educational materials and campaigns, developing quality improvement initiatives, or for provider performance incentives or value-based contract design. Providers can look at their own utilization and prescribing patterns for these low value services to identify potential areas for improvement. Health plans can use the findings in this report to help inform benefit design and utilization management strategies, as well as update medical policies to better reflect evidence-based recommendations.