Addressing Low-Value Care

July 8, 2021

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Health care costs have been rising in the United States in recent years. Many in the health care industry have been looking at ways to curb this steady increase. One way is to cut down on unnecessary treatments and tests or low-value care. 

A large part of health care spending goes toward services that add little value and can expose patients to added harm. By some estimates, as much as $226 billion is spent annually for unnecessary treatments, tests and services. In 2019, health care spending in the U.S. increased by 4.6 percent.

Then the pandemic slowed down or stopped health care services around the country. Hospitals canceled surgeries, and individuals delayed routine exams or treatments. 

“Prior to the pandemic, low-value care was high, but all care dropped during the pandemic, including low-value care,” says Michelle Davis, a director with BlueCross BlueShield of South Carolina who is working on a team to address the issue. “One of the opportunities we see is through efforts we're undertaking to make more room for high-value care by keeping low-value care from returning to its pre-pandemic levels.” 

A few examples of low-value care include imaging, such as X-rays for new-onset acute low-back pain, and vitamin D testing in general populations.

“These are tests that really offer little to no patient benefit in many situations,” says Davis. “The other issue is that low-value care decreases the amount of time doctors have to spend on high-value care.”  

These unnecessary treatments can also lead to higher out-of-pocket costs for patients and more testing, according to the Low-Value Care Task Force. By some analyses, patients pay as much as 33 percent of spending on low-value care. 

Low-value care can also cause harm either directly related to the procedure or from additional services or incidental findings. And when time is hard to come by, low-value care is a waste of time for patients and providers. 

BlueCross is working with providers to encourage a more thoughtful approach to ordering these tests or procedures that is based on nationally accepted, evidence-based guidelines. 

“We see this as an opportunity to discourage low-value procedures. If we don't intervene in some way, low-value care is going to return to its previous rates,” Davis says. 

For members, the key takeaway is to become an engaged and active participant in health care decisions. Ask questions any time a doctor orders a test or procedure: 

  1. Do I really need this test or procedure? 
  2. What are the risks and side effects? 
  3. Are there simpler, safer options? 
  4. What happens if I don’t do anything? 
  5. How much does it cost, and will my insurance pay for it?

For more resources on what questions to ask, visit the Choosing Wisely website

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