Eliminating Low-Value Care, Promoting High-Value Care – Smart Care Florida
The Challenge
- Low-value care most often refers to medical tests and procedures that should not be performed given their potential for harm or the existence of comparable effective and often less expensive alternatives.
- Low-value care is estimated to account for 30% of all care.
- Reducing low-value care can both lower overall costs and increase quality. This also ensures there are enough resources available for high-value care.
- Before low-value care can be reduced, it must be identified and described.
“This pandemic has uncovered a flaw in current benefit designs that do not provide affordable coverage for critical services — including care to treat COVID-19-related illness. Now that COVID-19 has exposed this problem to all Americans, the time has come for public and private health insurers to revisit their benefit designs to provide better access to essential services and deter the use of low-value care.”
Mark Fendrick, MD, Director of the University of Michigan Center for Value-Based Insurance Design
Our Solutions
Through our Smart Care Florida initiative, we have advanced a number of targeted strategies to address this challenge and drive positive change:
- We have actively promoted the Choosing Wisely program since its inception. It is an initiative of the American Board of Internal Medicine (ABIM) Foundation that seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. We also use their work to guide our research and identify focus areas. Learn more about Choosing Wisely.
- Representatives from the Florida Alliance for Healthcare Value participate in the Low-Value Care Task Force at the University of Michigan Center for Value-Based Insurance Design which has identified five low-value strategies to pursue:
- Diagnostic testing and imaging prior to surgery
- Vitamin D screening
- Prostate-specific antigen (PSA) screening in men over 75 years of age
- Imaging in the first six weeks of low back pain
- Branded drugs when generics are available
- The Center for Value-Based Insurance Design at The University of Michigan has developed VBID, a model plan that specifies high- and low-value services, including the cost-sharing changes necessary to result in the same or lower total medical spending. The Florida Alliance for Healthcare Value is investigating this design, which was developed for the individual market, to see if there are elements our employer members can incorporate and advance.
- We are engaging an employer steering committee to guide all of our work on eliminating low-value care.
- The Florida Alliance for Healthcare Value is working on a nonessential drugs project and developing a biosimilar promotion project with one of our affiliate members to help drive down the high cost of drugs.
“There is enough money in the US healthcare system. We just spend it on the wrong services and in the wrong places. Clinically-driven plan designs like V-BID X that reduce spending on low-value care create headroom to allocate spending to high-value services without increasing consumer’s premiums or deductibles.”
Mark Fendrick, MD, Director of the University of Michigan Center for Value-Based Insurance Design
Contact
For more information about the Smart Care Florida program, please contact Karen van Caulil, PhD.
