Strategy for "Choosing Wisely"

Photo: Money and sthetoscope

"Value-based" strategies could be
designed more effectively in order
to cut the use of low-value
services or drugs;© panther-

These efforts transcend economic impact, however, and may also be essential for improving health care quality and patient safety.

The piece follows last spring's launch of the "Choosing Wisely" initiative, a project of the American Board of Internal Medicine and Consumer Reports magazine. This public and physician education campaign identifies procedures and tests that add little value and may be unnecessary or even cause harm. The campaign encourages stakeholders to improve consideration and discussion of the proper uses of these services.

Several seemingly promising strategies have been proposed to encourage the use of high-value services and discourage low-value services, but they yielded mixed results. For example, a study aimed at improving medication adherence among heart attack patients by eliminating co-pays for medications such as statins appeared to make conceptual sense, but in the end failed to show a significant reduction in subsequent cardiac problems or health care spending. And other studies involving higher co-pays resulted in prescription-drug cost savings, but led to higher rates of emergency room visits and hospitalizations – so no money was saved overall.

The Penn researchers suggest, however, that these "value-based" strategies could be designed more effectively in order to cut the use of low-value services or drugs. Bringing cost sharing strategies in line with evidence-based screening guidelines, for instance, might play a role in reducing expenditures. If prostate-specific antigen testing – no longer supported by the U.S. Preventive Services Task Force – were no longer covered by insurance plans and physicians were instead required to discuss why the service may actually harm patients, they write, it would "send a powerful signal to patients, who may generally assume that all health care services provided are of high value."

"Incorporating insights from psychology and behavioral economics that help reveal how patients make these decisions is also important," says lead author Doctor Kevin Volpp. "That process is quite nuanced, and while insurance benefits can be designed to help steer patients away from low-value care, in many cases patients will need help from their providers in determining which care falls into that category and why."; Source: University of Pennsylvania