Providers are moving toward paying for value with two key approaches: encouraging simple high-value methods like a follow-up phone call with patients, and discouraging low-value, pricey services like unnecessary testing.
Both have their challenges, but the latter has been a particularly hard nut to crack. It's not for lack of trying.
One leading effort is at the University of Michigan's Center for Value-Based Insurance Design, created in 2005 to explore ways to lower financial barriers to high-value clinical services. The initial goal was to align patients’ out-of-pocket costs with the value of services. Now they're taking on the second part of the equation.
“We have more than enough money in the system. We can use more on good stuff and less on bad stuff,” Dr. A. Mark Fendrick, IHPI member, professor and director of the center, told Heathcare Dive.
For more than a decade, a number of initiatives have attempted to drive down use of low-value services. Providers know such tests and procedures can cost billions, harm patients, cause high out-of-pocket costs and lead to lost productivity and patient frustration.
But it’s also difficult to get clinicians to stop ordering tests and procedures when it’s been ingrained in them. That’s particularly true when few programs have shown consistent and verifiable progress, and patients face frustrating choices they often aren't equipped to make.
Low-value care and patients
When payers and employers look to cut costs, it’s often on the backs of consumers, or by influencing where they get care.
Anthem recently required members to get CT scans and MRIs in outpatient facilities rather than hospitals unless it’s an emergency. The payer also stopped paying for emergency department visits it deems unnecessary in hopes of getting members to visit less costly retail clinics and urgent care centers.
Putting more financial burden on patients is another strategy. A key tenet of high-deductible health plans is giving patients “more skin in the game.” The theory is that putting more service costs on the individual will make the patient choose care wisely. Members are often interested in HDHPs because they have lower premiums than other plans.
But patients are largely confused by their choices. Patient education programs, which were seen as a key plank to these consumer-driven plans, have not increased patient literacy overall. Plus, patients often have a difficult time even finding the cost and quality data they need to make informed decisions. So, in fact, HDHPs have moved more costs onto patients without actually helping them become better healthcare consumers.
Fendrick is no fan of such efforts and said the focus should be on changing habits through incentivizing cost and quality by increasing high-value care and limiting low-value care within the healthcare system.
“I don’t like this idea of asking my patients to shop around for their colonoscopy,” Fendrick said.
Recent evidence supports his view.