Alliance Releases the Latest Waste Report
We’ve gotten a lot of attention from our latest report released last week, using the Milliman MedInsight Health Waste Calculator™ (Calculator) to look at waste in terms of the 47 tests, procedures, and treatments commonly recognized as overused by the Choosing Wisely® campaign and the U.S. Preventive Services Task Force. The response from all corners of the state and national leaders has been truly overwhelming as legislators, hospital administrators, doctors, and plans, have called or written to me to congratulate us on the report; “incredibly important,” “a game-changer,” “absolute home run,” “great work,” “thank you for your determination and courage,” and “this is what courage looks like for all involved.”
As is true with all of our work, the credit is shared. When the Alliance started showing results from the Calculator last year, the Quality Improvement Committee, a group of 25 physician leaders from medical groups, integrated delivery systems, and health plans asked “Can you drill down into this data and give medical groups something to really work with, like how they are each doing on these waste categories?” In September, we presented them with our findings—both for multiple years, from 2014 through 2017 and at a medical group level.
But what they saw was blinded results, from the least to most wasteful medical groups from all over the state. When asked whether the Alliance should publish the blinded results or identify the medical groups in its report, the QIC’s response was very encouraging, “Not only should you release them, you are obliged to.” Bear in mind that none of the physicians knew where their medical groups fell on the spectrum, just that they, and everyone else, should know.
As it is well-documented, waste is no small problem, JAMA’s recent report Waste in the US Health Care System, estimated that waste comprises 25% of the total cost of health care in the nation at an annual cost of $100 billion in overuse alone. Of the 9,526,365 services the Alliance examined for both the commercially and Medicaid-insured in Washington state for the 47 measures in the Calculator, 51% were determined to be low-value, meaning they were either wasteful or likely wasteful and resulted in an average of 846,973 people receiving at least one low-value service each year (that’s equivalent to approximately 11% of the total state population), at a total estimated cost of $703 million.
Low-value care is not only wasteful, but may have serious repercussions for those patients in terms of potential physical, emotional, and/or financial harm. Our latest results show us the 10 areas that accounted for more than 90% of the low-value care we found in our analysis. Among them are these types of care:
- annual cardiac screening for low-risk individuals
- opiates prescribed for acute low-back pain in the first four weeks
- antibiotics prescribed for upper respiratory and ear infections
- pre-operative lab studies prior to low-risk surgery for low-risk individuals
- eye imaging tests for patients without significant eye disease
- too frequent screening for cervical and prostate cancer and Vitamin D deficiency
If we were to focus just on these areas, we could inspire tremendous change both here and, potentially, create a ripple effect the size of a tsunami for the rest of the country to do the same. And we are already heading in the right direction. Our results appear to show that there has been a 10% reduction in waste for the commercially-insured and a 24% reduction for the Medicaid-insured from 2014 to 2017, evidence that treatment behaviors appear to be changing.
Am I proud of the Alliance’s latest analysis? Yes.
Am I inspired by the courage shown by physician leaders to draw back the curtain on waste? Undoubtedly.
To the Alliance’s Quality Improvement Committee, I say thank you, but moreover, I say thank you to the medical groups in this report. Thank you for standing up and being counted. Without your willingness to participate in this kind of disclosure we would not be here together, on the leading edge of pushing transparency on the topic of overuse and potentially harmful low-value care.
But you know what I’m looking forward to most? How far we can progress in eliminating unnecessary care by the next time we take out our Calculator.
I hope you will stay tuned and dig in with us to eliminate unnecessary care in our state.
All the best,
Nancy Giunto