Unprecedented report from Washington Health Alliance shows performance for 44 medical groups across the state.
SEATTLE. Low-value services in Washington state’s health care system decreased from 2014 through 2017, according to Washington Health Alliance’s latest edition of its First, Do No Harm report using the Milliman MedInsight Health Waste CalculatorTM. Analyzing health claim data for more than 4 million individuals and 9.5 million services for the 47 tests, treatments, and procedures known to be overused and identified by the national Choosing Wisely® program and the U.S. Preventive Services Task Force,the Alliance found that waste declined by 10% for the commercially-insured and for the Medicaid-insured, the decline was more than double that—24%.
“While we don’t have a full explanation for this reduction in low-value care from 2014 through 2017, we can all agree this is an encouraging trend that we hope indicates that here in Washington, we are starting to take action to reduce waste,” says Executive Director Nancy Giunto.
The Alliance’s results show that 51% of the treatments examined were considered wasteful or likely wasteful and were delivered to an average of 846,973 individuals each year at an estimated total cost of $703 million. This is the first report in the nation identifying the amount of low-value care provided by individual medical groups and at the same time looking at waste over time.Of the 44 medical groups included in the report, topping the list for the lowest number of wasteful services and costs associated with delivering that care for the commercially-insured population is Peace Health Medical, and for the Medicaid-insured, it is Seattle King County Public Health.
“We are very fortunate here that our medical groups are willing to take this unprecedented step and draw back the curtain on the problems with waste in our health care system,” Giunto continued, “they really are a model to other medical groups across the country to be just as courageous.”Nationally, experts agree that about one-quarter to one-third of what we spend on health care in this country is waste. From the list of 47 tests and treatments examined, the Alliance identified a handful of services responsible for more than 90% of the waste, including:
- opiates prescribed for acute low-back pain in the first four weeks
- annual cardiac screening for low-risk individuals
- antibiotics prescribed for upper respiratory and ear infections
- pre-operative lab studies prior to low-risk surgery for low-risk individuals
- too frequent screenings for cervical and prostate cancer and Vitamin D deficiency
“This list gives us a great place to start to reduce waste. We all need to make overuse in health care at the core of honest discussions about health care value in our state,” says Deputy Director Susie Dade. “Clinical appropriateness needs to be a criterion for high quality. Delivering tests and treatments to patients who won’t benefit from them is not good quality.”The Alliance makes several recommendations to reduce waste in Washington state, such as:
- making overuse part of discussions about improving health care value;
- encouraging clinic leaders to incorporate low-value care reduction in their practices;
- helping patients decrease the low-value care they request;
- transitioning from paying for volume to paying for higher value care; and
- requiring measuring wasteful care in contracts with doctors and clinics.
“This has to be a collaborative effort,” continued Dade, “no one can solve the problems in our health care system alone. Employers who pay for the majority of health care in this country, the health plans that administer it, doctors who provide the care, and even patients, they all have an important role to play in this discussion if we are going to make change.”
About the Washington Health Alliance
The Washington Health Alliance is a 501(c)(3) organization working collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to improve our health care system by offering a forum for critical conversation and aligned efforts by health plans, employers, doctors, start-ups, consumers, and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on health care quality, value, price, and spending. The Alliance is a nonpartisan 501(c)(3) nonprofit organization with more than 185 member organizations. The Alliance publishes the Community Checkup, a series of reports comparing the performance of medical groups, hospitals and health plans. For information about Alliance membership, contact Theresa Lampkin Tamura at ttamura@wahealthalliance.org.
About the Milliman MedInsight Health Waste Calculator
Increasingly, public and private purchasers, regional health improvement organizations, health insurers and others are looking for ways to identify and measure waste to fuel quality improvement efforts – and many are looking to the Health Waste Calculator. The Health Waste Calculator is an analytic tool powered by Milliman’s MedInsight software and encapsulates VBID Health’s market knowledge on wasteful healthcare spending. The tool identifies and quantifies the use of unnecessary or potentially harmful clinical services, including those defined by national initiatives such as the U.S. Preventive Services Task Force and Choosing Wisely®. For more information about the Health Waste Calculator, contact Marcos Dachary at marcos.dachary@milliman.com.
Date: October 29, 2019
Contact: Leslie Bennett
Phone: 206.454.2961
Email: lbennett@wahealthalliance.org