Reducing Use of Low-Value Health Services Could Produce Significant Savings

A new national study of adults with commercial health insurance found that although use of what are termed “low-value” medical services is modest, there is potential for considerable cost savings if spending on these services is reduced.

Low-value medical services are considered by experts to provide little value to patients given the cost and available alternatives, and include such services as spinal injection for lower-back pain and imaging for uncomplicated headache. The study, conducted by researchers from RAND Corporation and the University of Southern California (USC), was published as a research letter in JAMA Internal Medicine.

Lead author Rachel O. Reid, MD, MS, of RAND Corporation, and colleagues examined the medical claims of more than 1.46 million American adults and their spending on 28 low-value services around the nation. The patients were sampled from a 25% random sample of 2011-2013 Optum Clinformatics Datamart of UnitedHealthcare commercial claims for patients aged 18 to 64 across the country.

The researchers found that spending on low-value services totaled $32.8 million during 2013, and that 7.8% of the patients studied received low-value services in 2013. That accounted for 0.5% of total spending on healthcare (more than $22 per person) annually. The study also found that the Southern, Mid-Atlantic, and Mountain regions of the country had proportionately more low-value spending.

The researchers said their findings add evidence to the concept that reducing overuse of medical procedures could improve quality while reducing spending. It is estimated that $200 billion in healthcare spending in the United States is for overtreatment and is the reason the American Board of Internal Medicine Foundation launched the Choosing Wisely initiative to encourage healthcare providers and patients to discuss evidence-based medical practices when discussing medical services. Previous studies of low-value medical care focused on Medicare recipients or specific regions, whereas the present study evaluated the care received by a large group of nonelderly adults insured by one of the country’s largest commercial health insurance company.

The greatest proportion of spending was for spinal injection for lower back pain ($12.1 million), imaging for uncomplicated headache ($3.6 million), and imaging for nonspecific low-back pain ($3.1 million). Even though the study highlights services that are a small portion of all the low-value care patients receive, Reid noted, the potential savings from reducing these low-value services and others are still substantial.

Senior author Neeraj Sood, PhD, professor at the Price School at USC and director of research at USC’s Leonard D. Schaeffer Center for Health Policy, said that the fact that areas with high Medicare spending also appear to have greater use of low-value services among those with commercial insurance confirm that there are opportunities for cost saving, and that both private insurers and Medicare can benefit from efforts to reduce use of low-value care.

Furthermore, the finding that low-value spending was lower among patients who were older, male, black or Asian, lower income, or enrolled in consumer-directed health plans, which have high member cost-sharing, suggests that disparities in health care cut two ways.

“It may cause poor access to high-value care among vulnerable patients and overuse of low-value care among more advantaged groups,” said Sood. “Both need further attention.”