Washington Health Alliance Director of Purchaser Strategies Denise Giambalvo and Director of Data Management and Analyst Mark Pregler co-presented “Driving Market Change through Multi-Stakeholder Collaboration” at the Civitas Networks for Health Member Roundtable Meeting on May 23rd.

They reported on the analysis conducted by the Alliance in the first phase of this work, Aligning to Drive Value, with a report for eight employer/purchasers on the amount of low-value that was delivered to their members and families compared to the state average from January 1, 2016 through June 30, 2019 using the Milliman MedInsight Health Waste Calculator™. The highlights include:

• approximately 20% of individuals received at least one-low value service;
• more than $320 million was spent on low-value care by the eight purchasers;
• there was a higher rate of low-value care delivery, approximately 10% more each year, for the purchasers’ populations compared to the state average; and
• one of the most common low-value services provided was the prescription of opiates for low-back pain.

Looking statewide on the issue of low-back pain, analysis using the Alliance’s voluntary All-Payer Claims Database, found that in 2020, more than 72,000 individuals in Washington state received low-value care, including more than 140,000 unnecessary services such as X-rays, MRIs and CT scans and the inappropriate prescribing of opioids, at a combined cost of approximately $10 million.

Since the kickoff of the second phase of this project, bringing together 30 stakeholder organizations to work together “to improve the value of care for all patients with low-back pain in Washington state” in February 2022, there have been convenings both large and small, surveys conducted to share progress across all of the stakeholder groups (health insurance plans, physicians, purchasers, and allies), and the development of a care pathway to support higher quality health care delivery across the state.

If you are interested in joining this exciting project, contact Alliance Director of Purchaser Strategies Denise Giambalvo. The Collaborative is supported by the Arnold Ventures’ Provider Payment Incentives Portfolio.

To see the presentation, click here.