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WHA VBID Presentation March 2019 FINAL NEW Results from the Health Waste Calculator Task Force on Low-Value Care March 14, 2019 © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 1 Caveats For all of the following reasons, the results should be viewed as directional, rather than absolute. §48 measures §Claims data for approximately 4.3 million residents of Washington state §Prevalence of waste noted, including number of services and individuals impacted, is based on actual utilization. §Costs are estimated, based on Milliman’s Consolidated Health Cost Source database for Washington state. §Noted costs are only associated with the particular service in question, including professional and facility charges. Costs do not include “cascading harm.” §When using claims data, there is always a time lag. The results in this report are from July 2016 - June 2017. We acknowledge that performance improvement may have occurred since June 2017. © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 2 Caveats (continued) §Prevalence of waste noted, including number of services and individuals impacted, is based on actual utilization. §Costs are estimated, based on Milliman’s Consolidated Health Cost Source database for Washington state. Estimated costs are based on reference unit prices that represent the average cost of each service. Reference pricing for allowed amounts was used and estimates are based on the “case rate” method included in the Health Waste Calculator. §Noted costs are only associated with the particular service in question, including professional and facility charges. Costs do not include subsequent unnecessary tests, procedures, treatments, inpatient or post-acute care that subsequently resulted from the initial unnecessary intervention – this is called “cascading harm.” §When using claims data, there is always a time lag. The results in this report are from July 2016 - June 2017. We acknowledge that performance may have changed since June 2017. © 2019 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 3 Summary • Across the 48 measures, for both lines of business combined: • 2,934,526 services were measured, totaling an estimated spend of $849 million • 47.2% of measured services were found to be wasteful (1,383,720) • 2,034,761 individuals received services: 50.1% (1,020,081) received low value services • An estimated $341 million was spent on low value care • The overall “Waste Index” is slightly higher for the commercially insured population than for the Medicaid insured population (48.6% versus 45.5%). • Many of the top areas of waste are the same for both populations, but there are a few differences in how the services are ranked for each line of business. • Ten out of 48 areas of waste measured account for 88% of the total. © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 4 Health Waste Calculator Results Overall (Commercial, Medicaid Combined) 48 Measures, 1 Year 2,934,526 services were examined 47.2% of services (1,383,720) were determined to be low value* *Low value includes LiKely WasteFul + WasteFul © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 5 Health Waste Calculator Results Overall (Commercial, Medicaid Combined) 48 Measures, 1 Year 2,034,761 individuals* received services 1,020,081 (50.1%) individuals* received low-value** services • Individuals counted each time they receive a service (i.e., distinct individuals are counted more than once if they receive more than one service) ** Low value includes Likely Wasteful + Wasteful © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 6 Health Waste Calculator Results Overall (Commercial, Medicaid Combined) 48 Measures, 1 Year Approximately $849 million was spent Approximately $341 million (40.2%) was spent on low-value* services *Low value includes Likely Wasteful + Wasteful © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 7 Low Cost, Low Value Services are a Big Driver 92% of all wasteful services found in this analysis (for the combined commercial and Medicaid populations) were very low cost (<$100) or low cost ($100 - $538). The break-down for each line of business in Washington shows some differences. © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 8 Wasteful Services by Measure Category (Commercial and Medicaid Combined) The 48 measures included in the Health Waste Calculator are grouped into six categories to organize results by types of care. Wasteful services in the Common Treatments (prescribing) and Screening Tests categories account for almost two thirds of all wasteful services measured in this analysis. The waste index varies considerably based on the category. Total # of Total # of # of Waste Category Services Wasteful Measures Index* Measured Services* Common 5 486,449 470,034 96.6% Treatments Diagnostic 19 320,095 191,889 59.9% Testing Disease 11 592,976 163,740 27.6% Approach Pre-op 4 230,152 143,121 62.2% Evaluation Routine 1 39 39 100% Monitoring Screening 8 1,304,815 414,897 31.8% Tests *Includes Likely Wasteful and Wasteful Routine Monitoring (not included in chart above) = <1% Total 48 2,934,526 1,383,720 47.2% © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 9 Targeting Key Drivers of Waste Ten out of 48 measures account for 88% of the waste measured for the combined population (commercial and Medicaid). These ten include the following which are listed in priority order based on the number of wasteful services measured: 1. Opiates for Acute Low Back Pain in the First 4 Weeks 2. Antibiotics for Upper Respiratory and Ear Infections* 3. Annual EKGs or Cardiac Screening for Low-Risk Individuals* 4. Imaging Tests for Eye Disease* 5. Preoperative Baseline Laboratory Studies Prior to Low-Risk Procedures* 6. Two or more concurrent antipsychotic medications 7. Routine PSA Screening for Prostate Cancer* 8. Cervical Cancer Screening for Women* 9. Screening for 25-OH-Vitamin D Deficiency* 10.Prescribing NSAIDs for Hypertension, Heart Failure or Chronic Kidney Disease Seven of the ten areas of waste listed above were also among the top areas of waste from our first report (February 2018); these are noted above with an asterisk (*). © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 10 Opiates Prescribed for Acute Low Back Pain The charts below shows the total number of services measured broken down by Necessary, Likely Wasteful and Wasteful. The overall Waste Index is 92% for the commercially insured population and 95% for the Medicaid insured population. A total of 232,824 wasteful services were delivered, impacting 105,906 individuals at an estimated cost of $13.1 million8,10. This was ranked as the #1 area of waste for the Medicaid insured population, based on the number of wasteful services (versus #3 for the commercially insured population). COMMERCIAL–MEMBERS IMPACTED MEDICAID–MEMBERS IMPACTED Measure Likely Likely Necessary Wasteful Necessary Wasteful Wasteful Wasteful Opiates, Low Back Pain 4,543 7,615 42.011 3,125 13,069 43,211 © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 11 Antibiotics for Upper Respiratory and Ear Infections The charts below shows the total number of services measured broken down by Necessary, Likely Wasteful and Wasteful. The overall Waste Index is 99.95% for the commercially insured population and 99.93% for the Medicaid insured population. A total of 197,758 wasteful services were delivered, impacting 173,718 individuals at an estimated cost of $2.8 million8,10. This was ranked as the #2 area of waste for the commercially insured population, based on the number of wasteful services (versus #3 for the Medicaid insured population). COMMERCIAL–MEMBERS IMPACTED MEDICAID–MEMBERS IMPACTED Measure Likely Likely Necessary Wasteful Necessary Wasteful Wasteful Wasteful Antibiotics, URI & Ear Infection 53 0 94,642 60 0 79,076 © 2018 Washington Health Alliance. Proprietary, all rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance. 12 Annual EKGs or Cardiac Screening for Low-Risk Individuals The charts below shows the total number of services measured broken down by Necessary, Likely Wasteful and Wasteful. The overall Waste Index is 32% for the commercially insured population and 23% for the Medicaid insured population. A total of 196,123 wasteful services were delivered, impacting 179,623 individuals at an estimated cost of $62.2 million8. This was ranked as the #1 area of waste for the commercially
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