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Seven Low-Value Services to Look Out For

October 2019 | Written by Abiy Agiro, PhD

Low-value care consists of services with little to no clinical benefit compared to risk of harm [1]. Reducing low-value services can help make healthcare more affordable over time without compromising the health outcomes of patients.

The Choosing Wisely Campaign is a national initiative of the ABIM Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures. It consists of nearly 80 consensus-driven lists produced by specialty societies of medical practices or procedures of minimal clinical benefit to patients in most situations, with potential do-not-do recommendations regarding judicious use.

HealthCore conducted a claims-based analysis to determine the effectiveness of this campaign on seven of the earliest low-value services. Using claims data, we quantified the frequency and trends of some of the earliest Choosing Wisely recommendations using nationwide commercial health plan population-level data.

Trends among Seven Low-Value Services

  • Imaging tests for uncomplicated headache decreased from 14.9 percent to 13.4 percent
  • Cardiac imaging without history of cardiac conditions decreased from 10.8 percent to 9.7 percent
  • Use of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for members with hypertension, heart failure, or chronic kidney disease increased from 14.4 percent to 16.2 percent
  • Human papillomavirus testing for women younger than 30 years increased from 4.8 percent to 6.0 percent
  • Use of antibiotics for acute sinusitis remained stable at 84 percent.
  • Preoperative chest x-rays with unremarkable history and physical examination results remained stable at 92 percent
  • Low back pain imaging without red-flag conditions remained stable at 54 percent.

Everyone can play a role

These results suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations. Providers, patients, and health plans alike can facilitate uptake of the do-not-do recommendations through a variety of efforts.

Healthcare providers can measure clinicians on how well they do on low-value services by using scorecards, providing clinician communication training, and facilitating clinical decision support through electronic medical records.

Patients can discuss the most appropriate treatments and procedures with their healthcare provider with the help of patient-centered resources available on the Choosing Wisely website or mobile app.

Health plans can help by creating financial incentives to reduce the use of low-value services while promoting high-value services through strategies like value-based insurance design and value-based bundled payments.

[1] Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet. 2017 Jul 8; 390(10090): 156-168.
Abiy Agiro, PhD
Director, Comparative Effectiveness, Translational Research

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