Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

Charlesworth, Christina J.; Meath, Thomas H. A.; Schwartz, Allen D.; McConnell, K. John

doi:10.1001/jamainternmed.2016.2086

Cited by 67 publications

(72 citation statements)

References 20 publications

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“…However, higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians in the patient’s home region were all associated with an increased risk of receiving these low-value services in Alberta. Although our finding that 5% of adults who had seen a physician at least once received low-value care seems lower than the 8%6 to 11%5 reported in the USA, we only examined 10 services (compared with 165 and 286 in the US studies). Our finding that low-value care was provided at least once to 30% of Albertans over age 75 mirrors reports from the USA of 25%–42% in Medicare beneficiaries—again we only examine 10 services while the Medicare studies included another 16 services, which we could not reliably extract from administrative records 2 3…”

Section: Discussionmentioning

confidence: 79%

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

et al. 2017

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Objective To determine how frequently 10 low-value services highlighted by Choosing Wisely are done and what factors influence their provision. Methods This is a retrospective cohort study using routinely collected health data from five linked data sets from 2012 to 2015 in the Canadian province of Alberta to determine the frequency with which 10 low-value services were provided. Results Between 2012 and 2015, 162 143 people (4% of all 3 814 536 adult Albertans and 5% of the 3 423 135 who saw a physician at least once in that time frame) received at least one of the 10 low-value services, including 29.8% of Albertans older than 75 years (57 811 of 194 068). The proportion of adults receiving low-value services ranged from carotid artery imaging in 0.1% of asymptomatic adults without cerebrovascular disease, to prostate-specific antigen (PSA) testing in 55.5% of men 75 years or older without a history of prostate cancer. Although age, Charlson scores and frequency of primary care visits were associated with low-value service provision, the directions of the association differed across services; however, higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians in the patient's region were associated with an increased risk of receiving all of the low-value services we examined. The low-value services which resulted in the greatest costs to the healthcare system were cervical cancer screening in women older than 65 without history of cervical dysplasia or genital cancer, PSA testing in men older than 75 without history of prostate cancer and preoperative stress testing/cardiac imaging before non-cardiac surgery. Conclusions Even within a universal coverage healthcare system, the proportion of patients receiving low-value services varied widely (from <0.1% to 56%). Increased use was associated with higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians.

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Section: Discussionmentioning

confidence: 79%

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

et al. 2017

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“…The similar prevalence of overuse nationally of each service, comparable patterns of regional variation, and high correlation within HRRs between the two populations suggest a place or health system effect, and little influence of payer differences, driving, or deterring overuse. Previous work compared low-value care among Medicaid and commercially insured populations at the state level (Charlesworth et al 2016) and similarly found no consistent association between insurance type and provision of low-value care. Work by others (Arora and True 2012;Chen et al 2014) also suggests local norms of care may develop through training and peer interactions, and these norms may have profound cumulative effects on the costs and quality of care from HRR to HRR.…”

Section: Discussionmentioning

confidence: 91%

“…Previous work compared low‐value care among Medicaid and commercially insured populations at the state level (Charlesworth et al. ) and similarly found no consistent association between insurance type and provision of low‐value care. Work by others (Arora and True ; Chen et al.…”

Section: Discussionmentioning

confidence: 93%

Payer Type and Low‐Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

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Morden

Sequist

et al. 2017

Health Services Research

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“…10 We also analyzed performance on five measures of appropriateness or “low-value” care (appropriate medications for people with asthma; testing for children with pharyngitis; imaging studies for low back pain; imaging for uncomplicated headache; and avoidance of unnecessary cervical cancer screening), hypothesizing that these services might be areas of focus for organizations seeking to reduce spending and improve quality. 11,12 …”

Section: Study Data and Methodsmentioning

confidence: 99%

Oregon’s Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures

et al. 2017

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In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations also demonstrated reductions in avoidable emergency department visits and improvements in some measures of appropriateness of care, but also exhibited reductions in primary care visits, a potential area of concern. Oregon’s coordinated care organizations could provide lessons for controlling health care spending for other state Medicaid programs.

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Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

Cited by 67 publications

References 20 publications

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

Payer Type and Low‐Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

Oregon’s Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures

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