The report, “First, Do No Harm: Calculating Health Care Waste in Washington State“ utilizes the new MedInsight Health Waste Calculator from the actuarial consulting firm Milliman, to produce an analysis of low-value health care services across the state. The services measured include 47 common tests, procedures, and treatments that clinician-led national initiatives such as Choosing Wisely® and the U.S. Preventive Services Task Force have determined are overused.
Low-value health care services, also called overuse or waste, refers to medical tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases have the potential to cause physical, emotional, or financial harm to patients. Preventing harm associated with the delivery of health care is essential to improving patient safety. While harm is not intentional, it is particularly troublesome when it results from tests, procedures, and treatments that were unnecessary.
“This is a pioneering report for Washington state’s health care community,” said Nancy A. Giunto, executive director of the Washington Health Alliance. “Being able to measure specific areas of waste in the health care system is an important step forward. The results are stunning and provide a clear opportunity to educate patients and engage health care stakeholders on areas of improvement.”
Highlights from the report:
- This report examined 47 common treatment approaches known to be overused.
- More than 45% of the health care services examined were determined to be of low value.
- Approximately 1.3 million individuals received one of these 47 services; among these individuals, almost one-half (47.9%) received a low-value service.
- 36% of spending on the health care services examined went to low-value treatments and procedures. This amounts to an estimated $282 million in unnecessary spending.
- Of the 47 treatments and services analyzed, 93% of overuse was attributed to just 11 common tests, procedures and treatments. These include such things as preoperative tests and lab studies prior to low-risk surgery, too frequent cancer screenings, eye imaging tests for people without significant eye disease, annual EKG tests or cardiac screening for people with low risk of heart disease, and imaging for uncomplicated conditions such as low back pain.
Many areas of overuse are individually low cost, but when they are used in high volumes they add up to tremendous waste. “Overuse in the healthcare system has become so common that we frequently don’t even think to question it,” Giunto said. “However, preventing harm to patients is critical, in addition to the fact that everyone pays the price because overuse contributes to higher insurance premiums across the board.”
The MedInsight Health Waste Calculator is an analytic tool powered by Milliman’s MedInsight software and encapsulates VBID Health’s market knowledge on wasteful healthcare spending. The tool identifies and quantifies the use of unnecessary or potentially harmful clinical services, including those defined by national initiatives such as the U.S. Preventive Services Task Force and Choosing Wisely®.
Only two other states in the country have utilized the MedInsight Health Waste Calculator, and only one of them has released results publicly. The public release of the Alliance’s Washington state findings will enable a much-needed community dialogue among key stakeholders about low-value care.
“The MedInsight Health Waste Calculator is a critical tool in the MedInsight suite of analytic products,” said Marcos Dachary, director of product management at Milliman. “We are proud to have worked with the Alliance to produce this vital report about the overuse of health care services in Washington state.”
To help reduce low-value care, physicians and patients should have conversations about appropriate medical care that is both necessary and evidence-based. The national Choosing Wisely® program, an initiative of the ABIM Foundation, offers the following tips to patients.
What can patients do to avoid overuse? Ask these 5 questions before you have a medical test or procedure:
- Do I really need this test or procedure?
- What are the risks and side effects?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- How much does it cost, and will my insurance pay for it?
- The measurement year used for the results in this report include services delivered between July 2015 and June 2016.
- The results in this report are based on an analysis of 47 specific health care services and approximately 2.4 million commercially insured people, and therefore should be viewed as a strong estimate rather than a comprehensive analysis of all health care received by all Washingtonians during the measurement period. Extrapolation of these results to other populations or types of care is not advised.
About the Washington Health Alliance
The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington State’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 160 member organizations. A cornerstone of the Alliance’s work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).
Washington Health Alliance
SOURCE Washington Health Alliance