A new report released by the Center for Improving Value in Health Care (CIVHC) shows that Colorado could save up to $140M annually and reduce potential harm to patients by minimizing low value health care services.

Low value health care refers to certain treatments, diagnostic tests, and screenings where the risk of harm or cost exceeds the likely benefit for patients. Providers, through medical boards and specialty societies, have collectively identified low value services available in the Choosing Wisely guidelines.

In an effort to understand where Colorado has opportunities to reduce low value care, CIVHC engaged the actuarial firm, Milliman, to run CO APCD claims from 2015-2017 through their MedInsight low value care tool. Health care claims for over 4.1 million people with both private and public health insurance were analyzed, and results show that in 2017, 1.36 million Coloradans received one or more low value care service, and 53% of the measured care received was identified as likely wasteful or wasteful.

“Reducing potentially unnecessary care is something patients and providers can readily address together, and it has the potential to have profound benefits on both cost savings and quality of care,” states Ana English, President and CEO of CIVHC. “This first view into low value care identifies focus areas we should consider addressing as a state.”

Of the 48 low value services analyzed, 13 services accounted for nearly 70% of the volume and over 80% of the spend for low value care. Across all payers, three services accounted for 44% of the low value care spending: Concurrent use of two or more antipsychotic medications ($25M), use of opioids for acute back pain before other treatments are tried ($19M), and use of peripherally inserted central catheters for dialysis patients ($18M).

Compared to two other states using the MedInsights tool, the percent of services considered low value (likely wasteful or wasteful) as a percent of all services examined in Colorado (35.3%) is very similar to Virginia (34.9%). However, the percentage of low value services in Colorado and Virginia was much lower than Washington State (47.2%).

Efforts to reduce low value care that have proven effective in other states include provider-focused and patient education interventions as well as multi-stakeholder collaborations. Initiatives should be tailored to address each unique low value care service as each needs to be evaluated based on the patient diagnosis and history, patient expectations regarding treatment, and payment incentives.

This initial report provides valuable information for many stakeholders including the state, payers, providers, employers and others looking for areas of improvement in both cost savings and quality of care, and makes the case that opportunities exist. As a next step, CIVHC is working to be able to provide data specific to providers, employer groups and others necessary to inform improvement activities at the local community level.

Categories: CO APCDNews