Residents who live in the north and southeast are more likely to receive a low-value healthcare service than those living in western and Midwestern states, according to a new analysis.
The report, published by researchers at consultancy Altarum and funded by the PhRMA Foundation, found that about 20% of members of a large national insurer living in Florida, New Jersey, North Carolina and New York received at least one low-value service in 2015 while roughly 10% of the insurer's members living in Alaska, North Dakota, Utah and Oregon experienced a low-value service.
Low-value services included imaging for low back pain, routine cervical cancer screening and opioids for headache treatment.
The findings are in line with other studies that have shown low-value care is more common in some areas of the country over others, said Beth Beaudin-Seiler, lead author of the study and senior analyst at Altarum.
The Altarum analysis doesn't dive into the causes for the disparities, but Beaudin-Seiler said local provider cultures might not be educated or invested in changing behavior, which would perpetuate low-value care.
"It seems to be more local practices that are providing low-value care rather than let's say a type of insurance carrier or a patient demographic," she said.
States with less low-value care may also struggle with accessing care, and many with smaller percentages of low-value care included significant rural areas.
Fee-for-service reimbursement may encourage low-value services by not discouraging providers to cull those practices, she added.
The analysis used claims data from an undisclosed national insurer that covers more than 12 million lives. The same dataset was used by Altarum for a similar analysis last year.
The analysis also found the most common low-value services were annual Pap smears for women ages 30-65, routine Vitamin D screening and the use of five branded drugs even though generics are available.
Beaudin-Seiler said each of the low-value services can happen for different reasons. Vitamin D screenings may be ordered without even the doctor's knowledge because electronic health records bundle that test in along with other routine tests. Annual Pap smears can be performed without a needed indication because the physician isn't caught up on the latest practice guidelines.
"The solution (to low-value care) is multifaceted," she said.
Fifteen of the 20 low-value services selected for the analysis were from the Choosing Wisely campaign and the remaining five were selected based on their recognition in the industry that these services don't add value to the patient.
To get the results, Altarum used an algorithm developed by Anthem that considers the codes in claims to determine if the service was necessary based on the patient's risk factors. Beaudin-Seiler said she's confident the services considered low-value in the study actually were because of Anthem's algorithm.
An estimated $5.5 billion was spent overall on the 20 low-services in 2015, the analysis found. That figure is extrapolated to represent all commercially insured patients nationally.
Beaudin-Seiler said solutions to low-value care involve providers and patients engaging as partners.
"Educating the patient is really important and giving them a way to be engaged is important," she said. "They have to start playing a role in their own healthcare in order to get high-value care and work with providers as a team."
States also have a role to play. Hospital associations can educate members and focus on goals in this area.
"There is a role for state-level organizations all the way through to individual provider groups," Beaudin-Seiler said.
