Alliance’s newest Health Waste Calculator report finds
significant opportunity to reduce low-value health care in Washington state.
SEATTLE – A new report on health care waste released this week by the Washington Health Alliance – looking at 48 measures of common medical treatments, tests and procedures – found that an estimated $341 million was spent on unnecessary health care in Washington state during a one-year period. The report found that of the 2.9 million services examined, 47% were found to be wasteful. Additionally, the report found that of the 2 million patients receiving one or more of the 48 health care services examined, one half – 1,020,081 individuals – received care considered low-value or wasteful.
“First, Do No Harm: Calculating Health Care Waste in Washington State” is the Alliance’s second report on health care waste using the MedInsight Health Waste Calculator from Milliman, an actuarial consulting firm, to analyze low-value health care services across Washington state between July 2016 and June 2017. The Alliance released its first report on this topic in February 2018; this newest report is an important next chapter. The number of areas of care examined have expanded, the measurement period has been updated, and the population included in the analysis almost doubled, now including both the commercially-insured and Medicaid-insured populations in Washington state.
“Nationally, experts agree that about one-quarter to one-third of what we spend on health care in this country is waste. This includes patients receiving unnecessary medications, tests and procedures that have been shown to have little benefit under certain clinical conditions and that create the very real potential for harm to patients – physical, emotional and financial harm,” said Susanne Dade, Deputy Director of the Washington Health Alliance and primary author of the report. “Based on our results for Washington state, the Alliance’s report underscores that waste in health care is a significant problem that is impacting millions of people and costing billions of dollars nationwide every year. “
Low-value health care services, also called overuse or waste, refers to medical tests and procedures that have been shown to provide little benefit in particular clinical scenarios and in many cases may have the potential to cause physical, emotional, or financial harm to patients. The services measured in the report included 48 common tests, procedures, and treatments that clinician-led national initiatives such as Choosing Wisely® and the U.S. Preventive Services Task Force have determined are overused.
“Preventing harm associated with the delivery of health care is essential to improving patient safety,” explained Dade. “While harming patients is not intentional, it is particularly troublesome when it results from tests, procedures, and treatments that were unnecessary to begin with and known by the medical community to be overused.”
The Alliance’s latest report is based on a substantially larger population, approximately 4.3 million individuals, and includes some new measures, such as “Opiates Prescribed for Acute Low-Back Pain in the First 4 Weeks.” The report found that this particular measure was the number one area of waste for the combined commercial and Medicaid population and underscores an opioid epidemic that is now commonly known to be a national crisis.
Of the 48 treatments and services analyzed, 88% of overuse is attributed to just 10 common tests, procedures and treatments. In addition to opiates prescribed for acute low-back pain, these include such things as:
- Annual EKGs and other cardiac screening for low-risk individuals
- Eye imaging tests for people without significant eye disease
- Preoperative tests and lab studies prior to low-risk surgery for low-risk individuals
- Too frequent screening for cervical and prostate cancer and Vitamin D deficiency
“We all need to work harder towards reducing low-value care,” says Nancy A. Giunto, Executive Director of the Washington Health Alliance. “Physicians and patients need to practice shared decision-making and have conversations about appropriate medical care that is both necessary and evidence-based. Those who provide and pay for health care need to undertake honest discussions and collaboration to identify the sources of waste and patient harm. We cannot continue to deny the problem of waste in health care.”
The entire report can be found here.
To learn more about steps patients, providers and others can take to reduce health care waste and receive high value care, visit the Alliance’s Own Your Health website, www.ownyourhealthwa.org.
About the Washington Health Alliance
The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 180 member organizations. A cornerstone of the Alliance’s work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).
About the 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 improvement efforts – and many are looking to the MedInsight 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, please contact Marcos Dachary at marcos.dachary@milliman.com
NOTES:
- The report includes results for both commercially insured and Medicaid insured individuals in Washington state. For purposes of this analysis, 4,357,768 distinct members were included; this total includes 2,227,570 commercially-insured individuals, and 2,130,198 Medicaid-insured individuals.
- Results in this report reflect examination of 48 common treatments, tests and procedures known by the medical community to be overused.
- Results should be viewed as directional rather than absolute. They provide a strong estimate rather than a comprehensive analysis of all health care received by all Washingtonians during the measurement period. Extrapolations of these results to other populations or areas of care not included in this analysis are not advised.
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