Beth A. Bortz, President and CEO of the Virginia Center for Health Innovation (VCHI), is clearly enthusiastic when asked about the sizeable nature of the statewide low-value care initiative that the Commonwealth of Virginia announced earlier this year, along with a $2.2 million supporting grant from Arnold Ventures.
The first part of the strategy for Smarter Care Virginia, as the pilot is known, involves a learning collaborative of six health systems and three clinically integrated health networks representing more than 1,000 practice sites and 7,000 physicians, all working to achieve a 25 percent relative reduction in seven provider-driven tests and procedures identified as low-value through the Choosing Wisely campaign.
Six of the care measures fall into the general categories of screenings such as annual EKGs, preoperative baseline testing and lab studies, while the seventh involves the use of PICC lines for patients with stage three or higher chronic kidney disease without a nephrology consult.
Using the state’s all-payer claims database and the Milliman MedInsight Health Waste Calculator, VCHI will provide quarterly reports to each of the six health systems, broken down both by practice and by individual clinician, detailing the provision of the identified low value care services.
“We’re super excited that health systems and integrated networks have stepped up significantly to work on this,” said Bortz, acknowledging the breadth of the pilot project. “We also recognize that if we’re successful, most likely, in a fee for service world, they will lose revenue.”
That’s where part two comes in: the formation of an Employer Task Force on Low-Value Care composed of many of the state’s largest employers, including the Commonwealth itself. The employers are charged with educating their peers about the challenges of low-value health care and identifying opportunities to creatively address financial impact, potentially working through benefit redesign with representative health plans.
“It’s equally important to have a parallel track [with employers] to prove you can achieve reduction,” said Bortz. VCHI announced 15 employer members in July and is hoping to add a few additional members; the task force will meet quarterly, starting this September.
Other actions the committee will take include reviewing their own workforce claims data to determine how much of a problem low-value care is with their employees, and discussing different levers to reduce consumer-driven overuse. The task force will select six consumer-driven measures to focus on based on this work.
“Nothing speaks louder than looking at your own data. That is what has gotten folks to sit up and really pay attention,” said Bortz, adding that separate strategies would be needed for educating providers and consumers about low value care. The health system learning collaborative and the employer task force will come together in two years to share what they have learned and to plot a path forward for improving health care value throughout Virginia.
Bortz said she was also encouraged because VCHI has been laying the groundwork for a statewide pilot since 2015, releasing reports on Choosing Wisely measures by provider and engaging selected provider communities, health plans and employers in candid conversations about what could and couldn’t be achieved in reducing unnecessary care.
She said clinical leadership teams will implement the reduction efforts within each system, and that VCHI will provide the resources and tools that they need. The center has already conducted daylong trainings on performance reporting and hosted webinars.
“We don’t know yet what will be the most effective approach. We are not prescribing a detailed specific protocol. Part of our evaluation will be gathering as much data as we can about what was done and the results,” Bortz said, noting one drawback in the pilot plan. Using the all-payer claims database won’t provide real-time data, as electronic health record system reporting would. But all parties said they could accept the time lag in order for all data reports to be consistent.
“We’re really excited that our partners are all in. I am not underestimating how many challenges are still to come, particularly with any venture of this magnitude and involving data. But the fact that all these folks are sitting around the table saying this is a priority is more than half the battle,” she said.