Should Addressing Low-Value Care be a Policy Priority?

Last week, the Oregon Health Authority and the Oregon Health Leadership Council released a study which seeks to identify ways to lower the cost of health care by eliminating “low-value” services – medical treatments, tests, and procedures that have been shown to provide little benefit in certain clinical scenarios.

In the battle to rein in ever-increasing costs of hospital services and pharmaceutical drugs, this study may be a small piece of the conversation in decreasing health care cost. It is by no means a silver bullet.

The study, Better Health for Oregonians: Opportunities to Reduce Low-Value Care, utilizes the Milliman Waste Calculator, a software tool that looks at 48 measures, treatments, and procedures to identify and quantify low-value health care services. The Oregon survey included commercial insurance, Medicare, and Medicaid. Of all three groups, Medicaid had the lowest occurrence of “low-value” services and spent the least on this type of care.

Though our state leads most others in innovative and efficient Medicaid coverage, the conversation continues on how to reduce the cost while increasing the effectiveness of health care. Many pieces of legislation that have been introduced over the years, including capping pharmaceutical costs of specific drugs, importing less expensive drugs from other countries, and partnering with other states to increase our pharmaceutical purchasing power. None of these became law.

So in the 2019 regular session, the Oregon Legislature passed SB 889, which created a Health Care Cost Growth Benchmark program that controls the growth of health care expenditures in the state. This program is still in review by a governor-appointed committee to cap the cost growth of health care for commercial insurance and address other causes for the steady rise of health care costs.

We know that 50% of projected spending growth in our public health system is from increasing prices, meaning that the amount of money we spend on low-value care pales in comparison to what we could save if we had other cost-control checks in place.
Policy Concerns

There are also many factors that play into why decreasing the use of low-value care is complex and problematic. In November 2019, OHA Director Pat Allen gave a presentation about what the focus of the SB 889 cost-growth benchmark committee would be. An example of unnecessary services included a patient requesting an X-ray for a sprained ankle, even though their ankle was not broken. The assertion received bipartisan pushback as both Rep. Teresa Alonso Leon and Rep. Christine Drazan said women and people of color can be discriminated against in health care settings, which lead to negative health outcomes for those groups. Furthermore, if an OHP member does have a sprained ankle but wants an X-ray to be sure it is not broken, would it be medically ethical to refuse this service?
Preventive Care Decreases Cost

The Coalition for a Healthy Oregon (COHO) is dedicated to breaking down barriers like these by investing in the social determinants of health, like ensuring that Oregonians who do not speak English have access to certified interpreters, or hiring a graduation coach to ensure that children of color are graduating at the same rate as their white counterparts.

We’ve always known that preventative care, like an X-ray to ensure an ankle is not broken, a cancer screening, or educational attainment, saves us all money in the long run. With Medicaid having the fewest “low-value” services in this study, we hope the Health Care Cost Growth Benchmark committee utilizes this study as a small piece of the conversation instead of a catch-all response to solve the state’s rising health care costs.