6 provider organizations to use data to trim low-value care in Virginia

Sentara and its affiliate insurance arm, Sentara Health Plans, are among six health systems and three clinically integrated networks joining forces to reduce medical waste in Virginia.

Announced March 13 by Virginia Gov. Ralph Northam and funded by a $2.2 million grant from Arnold Ventures, the Virginia Center for Health Innovation (VCHI) will launch the statewide pilot to reduce medical tests and procedures that have been shown to add little or no benefit to a patient’s health and, in some cases, can even lead to potential harm.

The American Board for Internal Medicine kicked off a national dialogue on low-value care in 2012, when it identified more than 550 tests and procedures that should be questioned by providers and patients.

"VCHI looked at just 42 of these measures, using 2017 claims data for 5 million Virginians from Virginia’s All-Payer Claims Database and the Milliman MedInsight Health Waste Calculator, and identified 2.07 million unnecessary services costing $747 million,” says Virginia’s Secretary of Health and Human Resources, Daniel Carey, MD. “The data made it clear we needed to do much, much better.”

Michigan’s Center for Value-Based Insurance Design (VBID) will be joining the American Board of Internal Medicine, Virginia Health Information, Milliman and VCHI in leading the pilot.

Those participating in the initial project in Virginia include Ballad Health, Carilion Clinic, HCA and Virginia Care Partners, Inova and Signature Partners, Sentara and Sentara Quality Care Network, and VCU Health System. Altogether, the clinical groups represent more than 900 practice sites, said a statement issued by VBID.

Barry DuVal, president and CEO of the Virginia Chamber of Commerce called the effort “both data-driven and highly collaborative.”

VCHI will start by aiming to reduce seven sources of provider-driven low-value care and then will expand to include a set of consumer-driven measures involving the formation of an employer task force on low-value healthcare.

Moss Mendelson, MD, medical director for Sentara Quality Care Network, says the initiative will enable Sentara Quality Care Network to focus on its own data and develop a better understanding of how to achieve better health for its patients. The analysis being used enables apples-to-apples comparisons among Sentara’s providers, he says.

Mark Fendrick, MD, director of the University of Michigan VBID Center, says Virginia has put together “a very rigorous evaluation strategy” and the pilot should provide some valuable insights in how to reduce unnecessary care.

“We have been watching Virginia grab the reins of low-value care reduction for the last couple of years and can’t wait to see what they accomplish with this grant,” Fendrick says. “The work they are proposing is necessary, ambitious and achievable. It could do a great deal to advance health value.”