Why High-Value Care Adoption Is Stagnant

Despite significant attention devoted toward transitioning overall U.S. healthcare spending from low to high-value care, little progress has been made towards increasing the value of healthcare spending systemwide, according to a new analysis.

The analysis, which was conducted by researchers at the Research Consortium on Health Care Value Assessment, looked at claims data from a large commercial insurer to track utilization of the selected five low-value and high-value services between 2014 and 2016. The dataset contained the complete medical and pharmaceutical claims for over 10 million enrollees from each of the 50 states and accounts for at least 5% of the privately-insured population in 24 states.

To obtain an estimate of spending trends for entire U.S. commercially insured population, researchers then extrapolated the frequency of use of these services per member within the claims dataset to estimates of the entire commercially-insured population in each year as estimated by the CMS National Health Expenditure Accounts data. The five low-value and five high-value services selected for this study were chosen through a consensus process among experts.

The five low-value care services selected for this analysis were:

• vitamin D screening tests,

• PSA testing in men over the age of 75,

• unneeded testing and laboratory work prior to low-risk surgery,

• imaging for uncomplicated low-back pain within the first six weeks of diagnosis, and;

• the use of more expensive branded medications when generics with identical active ingredients are available.

Low-value care consists of health services that provide minimal benefits to a patient and cumulatively contribute to high costs to the healthcare system. Estimates suggest that low-value care costs the United States health system hundreds of billions of dollars each year and contributes significantly to the country’s overall high cost of healthcare relative to other developed nations. For this analysis, researchers selected five frequently-cited low-value care services identified by the VBID Health Low-Value Care Task Force through a consensus process among task force professionals.

The five high-value care services analyzed by researchers in this study were determined through a literature review that incorporated recommendations from VBID Health, the National Committee for Quality Assurance, and the U.S. Preventive Services Task Force. The five high-value services included in this analysis were:

• retinopathy screening for diabetics, 

• influenza vaccinations, 

• HIV therapy drug regimens, 

• vaginal deliveries, and;

• healthy behaviors counseling (BMI counseling, tobacco counseling, and drug abuse counseling).

Related: Why Engaging Providers In Value-Based Care Will Be Even More Critical In 2019

“Results of the study suggest that the U.S has made little progress toward increasing the value of healthcare spending within the commercially-insured population by either reducing the use of low-value services or increasing the utilization of high-value services,” says study co-author Beth Beaudin-Seiler, PhD, senior analyst at Altarum and manager of the Value Consortium. “By examining claims data from a large commercial insurer, researchers found that spending growth on five select low-value services was mostly flat between 2014 to 2016 while spending on high-value services increased but did not outpace overall healthcare spending growth over that same period.

“These findings suggest that providers have been slow to reduce their utilization of services that deliver minimal benefits to patients nor have they substantially increased their use of high-value services that have the potential to deliver cost savings and better outcomes in the long run,” Beaudin-Seiler says. 

This study provides insights into how spending on high-and low-value care has changed over time, according to Beaudin-Seiler.

“Despite significant attention toward reducing low-value care services in the U.S. healthcare system, these findings show that the reduction has been relatively modest at least as far as these frequently cited services are concerned,” she says. “These findings also show that there are plenty of opportunities for providers to step up their efforts to reduce their utilization of low-value care and increase their use of services that deliver better value for patients.”