Reducing Low-Value Health Services Encourages Savings

adults (18 to 64 years of age) by reviewing more than 1.46 million commercial claims lodged at United Healthcare (UHC; Minnetonka, MN, USA) between 2011 and 2013. In all, 7.8% of the patients who put in claims received low-value services in 2013, with the total amount spent being USD 32.8 million, which accounted for 0.5% of total spending, or USD 22 per person annually.

The most commonly received low-value services included hormone tests for thyroid problems and imaging for low-back pain and uncomplicated headache. The greatest proportion of spending was for spinal injection for lower-back pain at USD 12.1 million, imaging for uncomplicated headache at USD 3.6 million, and imaging for nonspecific low-back pain at USD 3.1 million. Demographically, low-value spending was lower among patients who were older, male, black or Asian, lower-income, or enrolled on consumer-directed health plans, which have high member cost-sharing. The study was published as a research letter on August 29, 2016, in JAMA Internal Medicine.

“The services in this study reflect many clinical areas and types of care, but still are a small portion of all the low-value care patients receive. Our findings add evidence to the notion that reducing overuse of medical procedures could improve quality while reducing spending,” said lead author Rachel Reid, MD, of RAND. “The potential savings from reducing these low-value services and others are substantial.”

“Areas with high Medicare spending also seem to have greater use of low-value services among those with commercial insurance. This confirms that there are opportunities for cost savings, and that both private insurers and Medicare can benefit from efforts to reduce use of low-value care,” added senior author Professor Neeraj Sood, PhD, of USC. “Disparities in health care cut two ways -- it can cause poor access to high-value care among vulnerable patients and overuse of low-value care among more-advantaged groups. Both need attention.”

According to a 2012 report by the U.S. Institute of Medicine (IOM, Washington, DC, USA), more than USD 750 billion of health care spending annually represents waste, including approximately USD 200 billion in overtreatment. In order to reduce that amount, the American Board of Internal Medicine Foundation and consumer groups launched an initiative called ‘Choosing Wisely’ in order to encourage physicians and patients to engage in conversations about evidence-based medical practices.

Related Links:
RAND Corporation
University of Southern California
United Healthcare
U.S. Institute of Medicine