Commercial payers invested more than $5.5 billion in 20 select low-value healthcare services in 2015, according to a study by the Research Consortium for Healthcare Value Assessment, formed by Altarum.

No state scored below the ten percent threshold of members receiving at least one low-value care service among privately insured patients, with the worst performing states exhibiting twice that. While the study is limited to the prevalence of low-value care among the privately insured, prior research indicates that findings among publicly-insured are similar. Some suggest that low-value services are even more common among vulnerable populations.

“Our analysis shows how hard it is to change behavior in a health system or practice,” Beth Beaudin-Seiler, senior analyst at Altarum and lead author of the study, told HCB News. “It requires a focused effort to align attitudes, standard operating procedures, education, and incentives in order to move in the right direction. It also shows that clinical and financial incentives remain misaligned, but to get past this providers should continue working with payers to negotiate low-risk contracts built upon transparency and better infrastructure and data.”

The prevalence of low-value care was recorded as widespread, with some regional variance. Florida, New Jersey, North Carolina, New York and Alabama were the worst performing states, with rates going beyond the 20 percent threshold of members.

Incidences of low-value care are due to no single driver, with providers, systems and patients all contributing to it, according to the study. It is present regardless of payor type and anticipated reimbursement.

Researchers investigated potential causes by studying the three medical services most often required. The first was routine cervical cancer screening for women between ages 30 and 65. Together, these procedures cost $782 million. The team rejected the notion that patient preference for annual Pap tests was responsible for low-value care, instead pointing to providers who are not trained to conduct these exams with current best practices.

They also looked at population-based screening for Vitamin D, which in total costs $982 million. They assert that electronic medical systems programmed to complete tasks in one click are unintentionally perpetuating a low-value service in bundled laboratory panels. In addition, they found that patient preference may play a role in the use of brand-name drugs over generic equivalents ($1.57 billion), due to lack of education or financial incentives such as discounts and coupons for brand-name drugs.

The authors recommend quality improvement CME training to help providers reduce the frequency of Pap tests to align with recommended guidelines, as well as improved interoperability and clinical decision support applications to help blanket ordering of unnecessary panels through EHRs. They also suggest educating patients more and improving insurance plan designs to help reduce patient preference for brand-name medications.

“We've observed that provider organizations which implement a data-driven education and training program to change clinician behavior and systems to address an issue such as low-value care are the most successful,” said Beaudin-Seiler. “They should involve all clinical staff in training, gather baseline data from EHRs, assess progress every few months through data analysis, and make adjustments based on the data. All this is critical to achieving long-term behavior and system change.”

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