Delivery of Care

Welcome to Wonkville: calculating health waste costs, making them transparent

RIBGH hosts its annual health summit, crunching the numbers on what it termed the high-cost burdens of low-value health care

Photo by Richard Asinof

The annual health summit held by the Rhode Island Business Group on Health was focused on "low-value" care, featuring a panel discussion moderated by Dr. Michael Fine.

By Richard Asinof
Posted 10/8/18
The Rhode Island Business Group on Health held its annual health summit focused on low-value care costs, in an effort to make transparent unnecessary medical procedures that they say are driving up the costs of health insurance, as a way of harnessing corporate support for greater transparency of the data.
Where do the escalating costs of drugs fit into the equation of wasteful spending? How are the costs of social and health disparities calculated as part of the economic equation of health care delivery? What are the benefits of investing in prevention, particularly in children’s health, as compared to investments in managing chronic diseases, on a cost curve? What are the reasons behind the lowering of life expectancy in the U.S.? How do the externalities of environmental pollution and toxins in our air, water and food drive up the clinical costs of disease? Where do the rising demands for mental and behavioral health services in Rhode Island fit into the cost equation? What happens to patients when they tell their doctors or nurses no?
The same day as the health summit, ConvergenceRI listened as a colleague described the run-around in protocols attempting to get an MRI for a shoulder injury. Before an MRI could be ordered, an X-ray was required, followed by physical therapy, and then an MRI. The MRI revealed that there was a serious tear in the shoulder, and that some of the exercises recommended by the initial physical therapy were not appropriate for the injury sustained.
The value of listening to what the patient has to say often seems to get lost in the conversation around controlling health care costs.

PROVIDENCE – Much like the rising sea levels due to manmade climate change, medical costs keep increasing in the U.S., and the question remains unanswered: what is the best strategy to address the inexorable rise?

At the “Low-Value Care” Health Summit on Friday morning, Oct. 5, hosted by the Rhode Island Business Group on Health, there was a plethora of information, data and substance offered for one potential solution: eliminate “health care waste” in spending on unnecessary health care procedures, first by calculating the costs and then by making such costs transparent.

This year’s gathering was very much a follow-up to the focus of last year’s RIBGH health summit, about choosing wisely, empowering patients to ask the right questions of providers to limit unnecessary care options.

This year’s summit put the focus on diagnosing what is termed “Low Value Care,” diagnosing ways of translating the services that fell under that rubric and measuring them with tools such as a “Health Waste Calculator,” according to Marcos Dachary, director of Product Management for the stand-alone software tools at Milliman, one of the keynote speakers.

Simply put, the effort to control health care costs has been translated into a series of tools that can measure and track the amount spent on what was deemed unnecessary, low-value care: unnecessary pre-op tests for healthy patients before minor surgery; unnecessary PSA screenings; and too frequent cervical cancer screenings, among others.

Nancy Giunto, executive director of the Washington Health Care Alliance, and Beth Bortz, president and CEO of the Virginia Center for Health Innovation, followed Dachary with presentations about the power of transparency in making the costs, both to corporate partners and to health plans – and to legislators. The Washington Health Alliance reported finding an estimated $282 million in such “wasteful” costs; the Virginia Center for Health Innovation in turn reported finding about $568 million in low-value costs.

The goal of the conversation at the summit, according to the RIBGH flyer, was to “address next steps in the fight against this major cause of unaffordable health insurance.”

After the presentations, a panel discussion followed, moderated by Dr. Michael Fine, the former director of the R.I. Department of Health who now serves as the Senior Population Health and Clinical Services Officer at Blackstone Valley Community Health Care.

The panelists included: Dr. Matthew Collins, Vice President of Clinical Integration at Blue Cross and Blue Shield of Rhode Island; Al Ayers, director of Human Resources at Electric Boat; Patrick Tigue, director of the R.I. Medicaid program; Shannon Shallcross, co-founder and CEO of BetaXAnalytics; Dr. Pano Yeracaris, chief clinical strategist for the Care Transformation Collaborative; and Dr. Edward McGookin, chief medical officer at Coastal Medical.

Much of the conversation focused on how best to use the existing data, including the All Payers Claims Database, as a lever to drive change in policy decisions. There was some natural tension expressed between what the insurer wants, what the physician wants, and what the patient wants when it comes to medical procedures. As one panelist said, there were not many patients who were going to come into your office and say: I need a colonoscopy.

Another participant, from Neighborhood Health Plan of Rhode Island, said that the insurer was “prepared to be the bad guy” in order to hold the line on costs and unnecessary procedures.

Fine said that the numbers are compelling; that the amount of money spent on low-value care is astounding.

In the audience
There were plenty of attendees in the audience who could be said to be the intended targets of the conversation: Sen. Josh Miller, chairman of the Senate Health and Human Services Committee; Larry Warner from the Rhode Island Foundation; Marie Ganim, the R.I. Health Insurance Commissioner; and Kate Bramson, R.I. Senate policy director, among others.

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