The excitement in the room was palpable as 28 attendees descended on the Westin’s Earhart Room in Detroit, Michigan. Stakeholders from across the nation gathered on September 13 with a common goal—to reduce wasteful healthcare services in the United States. Our charge for the day was to prioritize 29 healthcare services that, in particular clinical scenarios, should not be offered even if they are free. These low-value healthcare services account for an estimated $210 billion or 27% of wasteful healthcare spending in the United States.1 The Task Force on Low Value Care narrowed the list to six measures, meant to serve as a starting point to reduce wasteful care.
Attendees represented a variety of stakeholders. Policy executives from Pfizer, Sanofi, J&J, and Amgen rubbed elbows with large employers such as Caterpillar, Walmart, GE, Comcast, and Hewlett Packard Enterprise. Employer coalitions from the Midwest and Pacific regions joined representatives from the Mid-America Coalition on Healthcare, the National Coalition on Healthcare, Network Strategic Initiatives, and the Independent Colleges and Universities Benefits Association. States were generously represented with attendees from the State Comptroller of Connecticut, the New York City Mayor’s Office of Labor Relations, and the Virginia Center for Health Innovation, which is embarking on the creation of a Virginia Health Value Dashboard. Health plan representation included epidemiology specialists from Kaiser Permanente Washington and Blue Cross Blue Shield of Massachusetts. The National Patient Advocate Foundation brought the patient perspective to the table, and representatives from MedInsight and VBID Health, collaborators on the MedInsight® Health Waste Calculator, provided insight on measuring and acting on the Task Force’s recommendations.
The Task Force used seven key criteria to identify the best services to start with. The first involved considering the potential for patient harm, whether physical, financial, psychological, or due to downstream procedures resulting from over-treatment. Recognizing the need for short-term wins to motivate continued action on this large problem, the Task Force also considered ease of implementation and identified measures where successful examples exist. For example, by requiring providers to select one or more of five evidence-based rationales, a health system in Alberta has seen a 92% reduction in unnecessary vitamin D screening. In order to make a significant impact on the issue, the Task Force also prioritized measures with high unit price, high prevalence, high aggregate spend, and high Waste Index (the proportion of services that are wasteful in each nuanced clinical scenario). Last, but equally as important, the Task Force considered political feasibility, selecting services that affect a variety of conditions in order to minimize consumer and provider backlash.
The list of six selected measures will be released in official communications by the Task Force. Five of the six measures are in production, allowing reliable quantification and trending with the MedInsight Health Waste Calculator.
- Smith, M., Saunders, R., Stuckhardt, L., & McGinnis, J. (2013). Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press.