Virginia’s secretary of health on Tuesday said a cross section of employers will help identify unnecessary medical tests that drive up the cost of health care without providing much benefit to patients.
Dr. Daniel Carey said during a meeting of the Virginia Center for Health Innovation that he will chair an employer task force as part of the state’s $2.2 million, three-year pilot project that seeks to shift millions of dollars away from useless tests.
The innovation center found in combing through 2017 insurance claims data for 5 million Virginians that about $747 million was spent on 42 types of tests and procedures that have little or no benefit to patients and are but a handful of the hundreds of such tests identified by the American Board of Internal Medicine.
“We definitely want to reduce the spending that we have in the commonwealth on services that are of low or no value, and may be potentially harmful,” said Beth Bortz, president and CEO of the center. “Everyone is in full agreement that is the priority.”
Bortz said the savings could then be spent more effectively.
“We want to improve value and to do that by spending less on things that are of little or no value and creating headroom to invest more in things that are of high value,” she said.
The center won a $2.2 million grant from Arnold Ventures, a Houston-based nonprofit, to look at reducing unnecessary care in two ways.
The first involves health care providers. Carilion Clinic, HCA, Ballad Health, Inova, Sentara and VCU Health Systems have agreed to work together to reduce the use of seven of the 42 low-value procedures.
Bortz said four are “drop the pre-op” procedures that include images and labs for low-risk patients before low-risk surgery, such as requiring an EKG before cataract surgery in a healthy patient with no history of heart disease.
All of the seven are provider-ordered tests.
The employer group will be asked to look at the remaining 35 tests and pick ones that consumers ask for that have little value, such as vitamin D screening and imaging for low-back pain.
“These are areas where typically what has happened is that the scientific evidence has changed, the recommended best practices from the medical specialists have changed, but that kind of the rest of the world hasn’t caught up,” she said.
She said one of the benefits of the employer task force is that the members’ human resources departments can help educate consumers about both the financial and health costs of unnecessary tests.
Employers also will be asked to look at ways to advocate for benefits designed to encourage high-value care.
Bortz said if the health systems succeed in reducing their seven measures, they are likely to lose money as they are still mostly paid fees for services.
“So they’ll be doing the right thing, but financially they will be penalized for it,” she said. “We felt it was really important that on a parallel track, we would be working with those who are paying for care, that being the employers, to make sure that they understand what the challenge of low-value care is, why it’s important that we work to reduce it, and working with them to achieve a couple things to help us think creatively about benefit design.”
The task force is expected to meet quarterly, starting in September.