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Mar 1, 2020

Reducing and avoiding low-value care

Last month, my column focused on the attributes of high-value primary care, its importance, and its advantages for providers, patients, and the healthcare system. This month, I wanted to focus on the opposite end of the spectrum: reducing or avoiding low-value care.

What is low-value care? It is any type of test, procedure, screening, or other type of healthcare that is clinically inappropriate or not needed, and has any cost attached to it. According to the Center for Value-Based Insurance Design, low-value care contributes more than $345 billion in wasteful health spending annually.

Some of the more prominent examples of low-value services include diagnostic testing and imaging for low-risk patients undergoing non-cardiovascular surgery, Vitamin D screening tests (nearly 90 percent of it may be clinically useless), PSA screening in men who are 75 or older, imaging within the first six weeks of low-back pain, and prescribing brand name drugs when identical generics are available. Read more about each of these examples here.

As a health plan, one of the most important roles that BCBSRI plays in the healthcare system is helping to ensure that our members and your patients get the right care at the right time and in the right place. We are advocates for appropriate care that helps patients, and I think we can all agree that we would want to receive care that helps us rather than harms us.

So, as a healthcare provider, how do you recognize whether care is high- or low-value? One of the most trusted sources to refer to for recommendations about potentially unnecessary tests, screenings, or procedures is Choosing Wisely®, an initiative launched in 2012 by the ABIM Foundation. We also recommend Choosing Wisely to our members as a resource for questions to ask their providers before getting any test, treatment, or procedure, or about any medications they are prescribed.

There are many good reasons why guidelines about low-value care may not always be followed. For example, it varies according to the clinical situation and the potential for complications. But the important takeaway is that there are some instances where care is not appropriate and should be recognized as waste. Patients should feel empowered to ask questions about their care, and as providers, you should welcome these questions. Health plans, providers, and patients all need to work together to recognize this trend and work together to reduce the amount of low-value care in the system. It benefits all of us.

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