New report evaluates low value care in Oregon’s health system

The Oregon Health Leadership Council (OHLC) and the Oregon Health Authority (OHA) on Monday released a report evaluating opportunities to reduce low value care in Oregon’s health system.

Low value care, as defined in the report, are services that are duplicative, not evidence-based, not truly necessary, and provide little benefit in specific clinical scenarios. These kinds of services might include opioid prescriptions for lower back pain in the first four weeks or imaging for uncomplicated headaches. Reducing these services offers a chance to reduce costs and improve quality in the health care system.

 

 

The report examined 47 common treatments, tests, or procedures known to be overused within the medical community over a three-year period (2016 – 2018) for all lines of business (commercial, Medicaid, and Medicare).

Of the over 9.56 million services evaluated, 40% were found to be low value. Nearly $530 million (32% of spending) was spent on low value care, and an average of 804,328 distinct individuals received at least one low-value service in each of the three years.

 

Image: The Oregon Health Leadership Council & the Oregon Health Authority

 

The percent of low value care services provided was highest in the commercial market, where 49% of all services were low value. Forty-five percent of services were low value for Medicaid and 31% were low value for Medicare patients.

“Medicare had the highest rate of low-value services per 1,000 members at 595.5, which is approximately 170% higher than the rate for the commercially insured population at 355.1. Medicaid has the lowest rate per 1,000 at 272.7,” reads the report.

The measures with the largest low value utilization are opioids prescribed for low back pain during the first four weeks, pre-operative baseline lab studies for low-risk patients undergoing low-risk surgeries, and annual cardiac screenings for low risk individuals. The report says these services are a good place to start when it comes to selecting targeted interventions to reduce low value care.

“We recognize that the provision of low value services is only one of several contributors to the continued increase in health care costs,” said Jill Leake, director of clinical strategies for the Oregon Health Leadership Council. “Our hope is that the information in this report serves as a catalyst for providers and health care leaders to advance positive change within their organizations and promote high value care for all Oregonians.”

Specifically, the report states that health care leaders can use the information to develop educational campaigns, develop quality improvement initiatives, or for provider performance incentives or value-based contract design. The information could also be used as a foundation for further analytics such as focused reporting to allow clinicians to better understand their individual utilization patterns.