High-Value Preventive Health Care May Also Result in Unnecessary, Expensive Services

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New Research from Betsy Cliff

Efforts to encourage high-value preventive medical care may, unintentionally, increase the use of health services that provide little or no health benefit, according to a new study by researchers at the University of Michigan School of Public Health.
Published in Health Affairs, the study examined an intervention that lowered cost-sharing for evidence-based, high-value preventive services, such as mammograms and colon cancer screening for specific populations.
"If we want to increase the efficiency of the health care system, we need to do more than encourage the use of high-value services," said Betsy Cliff, a doctoral candidate at U-M's School of Public Health and lead author of the study.
"We need to also explicitly discourage low-value services. They're not delivered separately in the health care system, so we shouldn't treat them separately when we're trying to encourage appropriate use of services."
Quality improvement programs have focused on increasing the use of high-value services. Cliff and colleagues focused on such an effort implemented in a state's employee health benefit program. The plan reduced or eliminated consumer cost sharing for targeted services including preventive visits, screenings and medications for management of chronic diseases.
The researchers used the administrative data of about 64,000 enrollees to look at service claims and dates for procedures and diagnostic codes and used guidelines from national organizations such as the U.S. Preventive Services Task Force and Choosing Wisely to categorize high- and low-value services. The study is published in the March issue of Health Affairs.
They found that the program increased the percentage of people who received a high-value preventive service from 60 percent in the year before implementation to 71 percent in the year after, an intended effect.
But, at the same time, it increased the percentage of the population receiving a low-value service from 34 percent in the year before the intervention to 42 percent in the year after, which was not intended by by program. Some of these services, such as vitamin D screening or cardiac screening, are recommended for specific populations but are often offered as part of preventive care services package to patients for whom they offer little or no benefit.
"The program worked really well to get people to start using the high-value services that they weren't previously using," Cliff said.
But more attention needs to be paid to disentivizing the low-value services, she said.
"Low-value care represents wasted money and likely ineffective medical care," she said.
Cliff said the analysis included data from the first two years of the program, which has made several changes since that time that may have mitigated the use of low-value services.
In addition to Cliff, authors included Richard Hirth, professor of health management and policy, and Mark Fendrick, professor of internal medicine and health management and policy. Both are members of U-M's Institute for Healthcare Policy and Innovation.

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