How is the United States progressing in measuring and reducing low-value care?
How is the United States progressing in its efforts to reduce low-value care?
To answer that question, a panel convened by the University of Michigan’s Center for Value-Based Insurance Design (V-BID) for its 2022 V-BID Summit included a cardiologist, an Arnold Ventures executive, and the executive director from the Washington Health Alliance to examine successful examples as well as the tools needed to measure progress.
With support from Arnold Ventures, the Washington Health Alliance created the Low Back Pain Implementation Collaborative. Nancy Giunto, who leads the alliance, said the topic was chosen by 29 stakeholder organizations, including buyer organizations, trade insurance schemes, large supplier groups and more. The choice was driven by data, she said.
According to the organization, an estimated 80% of Americans will have some form of back pain in their lifetime, but few receive high-quality care for it.
Giunto pointed out that the project is also about breaking down silos and bringing people together to discuss the issue.
“When you have a room full of health plan managers, purchasing managers and vendors, you know, we have Washington State specialists around this table from many different systems, who know direct care back pain patients and know the challenges. and when you get them to speak candidly about what’s wrong with the system, there’s some magic that we hope happens,” she said.
In another Arnold-funded project, the University of California, San Francisco (UCSF) is partnering with Medicaid managed care organizations to identify ways to reduce low-value care. The team receives feedback from other practitioners, said Rita Redberg, MD, MS, professor of medicine at UCSF.
Arnold Ventures, the well-known philanthropy that funds evidence-based research, also works with organizations on policy development, technical assistance and implementation support, said Erica Socker, PhD, vice president of the health care and philanthropy payer reform section.
“One thing that is really high on our list at the moment is to work on reforms to the financial incentives faced by providers, we believe that progress on this is essential to move away from the pay-as-you-go system. the deed and switch to alternative payment models,” she said.
“I think the promise of responsible care organizations [ACOs] is that you can really get the kind of high-level global incentives and make sure you’re not asking suppliers to work against their financial interests, which I just don’t think is a realistic thing to do,” said Socking.
Another recent focus is on creating very specific measures of low-value care in certain specialties to drive health system change.
Does cutting low-value care create room for more high-value care, asked moderator, Clifford Goodman, PhD, senior vice president, comparative effectiveness research, The Lewin Group.
There is anecdotal evidence in Washington state, Giunto said; some employers are modifying programs to move in this direction. She also agreed with Socker that incentives need to be better aligned to encourage providers to provide high-value care.
As a physician, Redberg raised another pitfall of low-value care — avoiding it isn’t just about cost; it is also about avoiding potentially harmful treatments.
“The main benefit is that you’re avoiding care that isn’t going to help someone and can only hurt them,” she said. “Because a lot of people, you know, even if the care was free, you don’t want to get care that’s not likely to help you, because you’re still at risk of harm.”
Socker touted physician-led ACOs in particular, noting that they were more successful than hospital ACOs because of the incentive structure.
“You allow a primary care doctor or another doctor to take advantage of it and derive shared savings. And I think that gives them an incentive, because they’re not reducing their own revenue,” she said, adding that some resources could then be reallocated to vendors who administer a high-value service.