Calculator Identifies Millions in Wasteful Care at Washington Health Systems

A new study from the Washington Health Alliance analyzed the impact of implementation of a waste calculator tool and identified millions of dollars in wasteful care annually.

Washington became the third state to implement the tool, known as the MedInsight Health Waste Calculator, which uses all-payer claims data to identify wasteful care based on initiatives such as the US Preventive Services Task Force and the Choosing Wisely campaign. The tool is powered by Milliman’s MedInsight software.

The study analyzed all-payer claims data from 1.3 million patients between 2015 and 2016. They analyzed 47 specific health care services that are typically known to be over-utilized. Of these 47 services, almost half were determined to have low clinical value to patients, providers, and payers.

“This is a pioneering report for Washington state’s health care community,” Nancy A Giunto, executive director of the Washington Health Alliance, said in a press release. “Being able to measure specific areas of waste in the health care system is an important step forward. The results are stunning and provide a clear opportunity to educate patients and engage health care stakeholders on areas of improvement.”

The researchers found that of the 1.3 million patients analyzed, 47.9% received a service that was deemed to have low value. They found that the total waste for these services amounted to $282 million.

They determined that 93% of over-utilization was the result of 11 low-value services, including “preoperative tests and lab studies prior to low-risk surgery, too frequent cancer screenings, eye imaging tests for people without significant eye disease, annual EKG tests or cardiac screening for people with low risk of heart disease, and imaging for uncomplicated conditions such as low back pain.”

“Overuse in the health care system has become so common that we frequently don’t even think to question it,” Ms Giunto said. “However, preventing harm to patients is critical, in addition to the fact that everyone pays the price because overuse contributes to higher insurance premiums across the board.”

—David Costill

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