Taking care of your employees is important, but how do you know you are paying for the right care?
When patients receive low-value care, meaning care that is duplicative or not supported by research, they pay more for unnecessary or inadequate care. Low-value care costs patients more money, and it also leads to higher costs for their employers. This is a problem because when employers spend more money on healthcare, they have less money to invest in other important employee benefits, including wages.
The Alliance recently hosted a webinar featuring representatives from the Wisconsin Health Information Organization (WHIO) Low-Value Care Committee. The WHIO maintains Wisconsin’s largest healthcare data and information system to inform evaluations of Wisconsin healthcare delivery and payment systems. In August 2023, the WHIO released a report, Achieving Healthcare Value in Wisconsin A Focus on Low Value Care, assessing the value of healthcare in Wisconsin and identifying areas for improvement. The Alliance’s webinar explained the findings of WHIO’s report to help employers understand how to identify low-value care and discussed ways for employers to encourage their employees to make shared decisions with their healthcare providers to avoid unnecessary and costly treatments.
Below is a summary of the discussion, but you can watch the full presentation here.
What is Low-Value Care?
According to the WHIO 2023 Low-Value Care Report, 32% of all healthcare purchased in Wisconsin was low-value with one out of every three people receiving low-value care services in 2019. So, what is low-value care?
The WHIO defines healthcare value as the quality of a service received compared to the price paid for that service. While it’s not possible to quantify the value of all healthcare services, certain services improve health outcomes and do not cost a lot (high-value care), while other services do not improve health outcomes and therefore should be avoided (low-value care).
To improve health outcomes without increasing the overall cost of healthcare, employers should encourage their employees to take an active role in their health to determine which care services are necessary and which may not be. In this way, we can work to decrease the use of low-value care and increase the utilization of high-value care in Wisconsin.
High-Value Care Services Improve Health Outcomes
- Higher grade screening tests
- Chronic disease management
Low-Value Care Services Do Not Improve Health Outcomes
- Services not supported by research
- Duplicative tests/procedures
- Services that may cause harm, waste resources, or add unnecessary costs
For example, an opioid prescription for acute disabling low back pain is considered low-value care because early opioid prescription is associated with longer disability leave and a higher chance of surgical intervention and addiction. In this case, the potential risks of the medication outweigh the benefits.
Another example of low-value care is annual resting EKG screenings for otherwise healthy people. There is little medical evidence that this testing improves health outcomes. In fact, it can have adverse effects. False positives can lead to misdiagnosis, harmful or unnecessary procedures, and increased stress. Again, the risks of this procedure outweigh the potential benefits.
Why Avoid Low-Value Care?
Low-value care affects everyone. It costs patients and their employers more money making it difficult for employees to afford healthcare and for employers to offer effective benefits without passing costs on to their employees.
Hidden Costs of Low-Value Care
- Poor use of limited provider staff time and increased wait times
- Duplicate or unneeded follow-up services
- Emotional and physical stress from additional appointments or unnecessary tests
- Higher insurance premiums (or more medical claims for self-insured employers) and out-of-pocket expenses for employees
- Lost work and personal time
- Added cost for travel and childcare
- Lower-quality healthcare services and greater cost inequities
How Can We Improve the Value of Care in WI?
Employers can help reduce low-value care by educating employees about the hidden costs of low-value care and encouraging their employees to advocate for themselves at their medical appointments. Encourage employees to ask their provider questions about their healthcare and treatment options. That way they can get the care they need and avoid unnecessary tests, procedures, and medications.
The following questions are a starting point for patients to have a discussion with their provider about what tests, treatments, and procedures are needed – and which may not be necessary.
Before Having a Test, Ask
- Do I need this test?
- Will this test change the course of my treatment?
- Could this test cause me harm?
- Have I had this test before?
Before Having a Procedure, Ask
- Do I need this procedure?
- What are my alternative treatment options?
- What are the risks and benefits of this procedure?
- Could this procedure cause me harm?
- Have I had this procedure before?
Before Starting a Medication, Ask
- Do I need this medication?
- How will this medication impact my health?
- What are the risks and side effects?
- Are there alternative treatment options?
- Are there lower-cost medications available?
Choosing Wisely, an initiative of the ABLM Foundation also offers resources to help patients begin a dialogue with their provider to make the best decisions for their health and their finances.
It is important for patients to be an advocate for their health. When employees save money by avoiding low-value care, they save themselves and their families money and maintain their health. They also save their employers money which they can reinvest in better benefits, including higher wages.
Another way employers can reduce low-value care in Wisconsin is by designing benefit plans that incentivize employees to utilize high-value care and avoid low-value care. The Alliance helps employers design customized tiered benefit plans that steer employees to preferred-value providers, providers who offer quality care at low costs. The Alliance® Premier Networks allow employers to customize their benefit plan to meet their employees’ needs and guide them to make smart healthcare decisions. In fact, we found that employers who used their data to guide employees saved more than 20% per member per month over employers that did not.
The Alliance also helps employers find high-value healthcare options by contracting bundled payments for shoppable (non-emergency) procedures. This allows patients to pay one fee for the entire episode of care.
Finally, employers can support health policies that lead to an increase in the overall value of healthcare by letting legislators know its importance for Wisconsin businesses, employees, and their families. If we work together, we can improve the value of healthcare in Wisconsin.