The Virginia Center for Health Innovation has won a $2.2 million grant to partner with health care providers and employers on a pilot project aimed at keeping patients from undergoing unnecessary tests and procedures that raise costs and anxiety, but provide little medical value.
Virginia Secretary of Health Dr. Daniel Carey announced the award from the Houston-based nonprofit Arnold Ventures during the University of Michigan’s Value-Based Insurance Design Summit. Virginia is one of two states working with partners across sectors to try to reduce what is considered low-value health care.
For example, not every woman needs a Pap test and not every man needs his PSA level measured year after year, nor does every patient require a battery of images, bloodwork and heart monitoring before surgery.
These are just a few of the more than 550 tests and procedures that the American Board of Internal Medicine identified as having a low value in its 2012 initiative Choosing Wisely.
Carey said Virginia’s health innovation center, which has access to a database of all insurance claims paid in Virginia, looked at 42 of these measures for 5 million patients using a heath-waste calculator and found more than 2 million unnecessary services costing $747 million.
“The data made it clear we needed to do much, much better,” he said in a news release.
Ashley Edwards, the center’s chief innovation officer, said the intent “is to free up resources from identified low-value services through Choosing Wisely and getting to more evidence-based care and shift to higher-value care. In the long term, the focus would be on more preventative screening.”
Edwards said an example of low-value care is widespread testing of vitamin D levels.
“It may seem like a small thing, but when it’s done thousands and thousands of times, it is costing patients and payers money. It may be the providers don’t know they are ordering it because with electronic medical records lab tests can be part of a package,” she said.
The center will work with Ballad Health, Carilion Clinic, HCA, Inova, Sentara and VCU Health System to establish a baseline on seven procedures and then work together to reduce them by sharing best practices.
The first thing the coalition will look at is an initiative called “drop the pre-op.”
Edwards said the No. 1 source of low-value health care in Virginia is unnecessary diagnostic testing and imaging for low-risk patients before surgery.
“For patients, it can reduce unnecessary time spent at a lab or clinic, reduce financial burden, reduce waiting for tests results and anxiety from false positive results, and reduce unnecessary delays before a procedure,” Edwards said.
“For physicians, it can reduce time spent reviewing, documenting and explaining test results that add no value and won’t impact a decision regarding a procedure and reduce risk exposure from not carefully documenting follow-up on all pre-op tests.”
Dr. Jon Gleason, Carilion’s chief quality officer, said that evidence-based practices for pre-surgery have been evolving.
“It’s important the care we provide evolves with it,” he said.
Gleason said the grant will have a broad impact on improving care across Virginia, as all of the partners will be looking at best practices.
This isn’t about doing fewer tests, but rather in doing the tests a patient needs, he said. A young person without pulmonary disease who’s having minor surgery wouldn’t need a chest X-ray. But someone facing complicated surgery that would stress the heart and lungs might benefit from one.
The pilot project will also seek to reduce cardiac testing, both EKGs and cardiac stress tests, for patients without symptoms; imaging for patients without symptoms or signs of eye disease; and peripherally inserted central catheters in stage III-V chronic kidney disease patients without a nephrology consult.
Edwards said the measures combined accounted for more than 1 million unnecessary services costing $494 million in 2016.
The center will also work with the Virginia Chamber of Commerce and Virginia Business Coalition.
“A huge part of this is the employer task force,” Edwards said, as data and evidence-based initiatives will be shared with employers so they can design benefit packages and educate employees.
Edwards said people with high deductibles and copays might be paying out of pocket for unnecessary tests.
The intent is not to ration care or make it difficult for patients to get testing and procedures that would benefit their health, she said.
“We have learned in our work that semantics is very important in talking about this issue,” she said. “For certain patients, some of these things are absolutely necessary.”