Building A Better Health Care System Post-Covid-19

In Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care, Corinna Sorenson, PhD, Duke-Margolis Center for Health Policy, and colleagues outline the impact of the pandemic on low-value care, and the potential opportunities it presents to create a better health care system post COVID-19. She elaborates further on this topic in her January 2021 Choosing Wisely webinar recording.

The Covid-19 pandemic has significantly postponed many services and increased non-contact strategies. Reduced health care utilization and the subsequent shift to telehealth has altered health care delivery dramatically. These changes create the opportunity to focus on high-value health care and re-evaluate the necessity of medical services. It is critical that this evaluation occurs immediately as re-opening occurs and as the health system transitions toward a new normal.

“This will not go away without some concerted action across all levels of health care. There are several short- and long-term actions that a variety of stakeholders can take to improve individual and population health,” said Sorenson.

Providers & Health Systems

• Development of immediate care plans for all patients, with a high-value care focus.
• Triage treatment for high-need patients, to avoid the emergency department (ED) whenever possible.
• “Do Not Restart” lists incorporated into point-of-care decision supports, such as alerts embedded into electronic health records.
• Leveraging alternative care pathways and care sites (telehealth, home-based, and community care).
• Tracking and evaluating use of low-value care and new systems of care delivery for impacts on health outcomes, quality of care, patient experience, known or new disparities, and costs.
• Alerting providers of their low-value care use, comparing it to their peers, and providing feedback on how to improve performance.
• “Low value care should be supported by senior leadership and embedded in the culture of value, trust and a learning orientation where providers and other team members are encouraged and supported to lead and innovate around low-value care reduction,” said Sorenson.

Support from Payers, Policymakers, Employers, and Patients

• Decrease or cease payment for low-value services and recommendations from professional organizations and practices.
• Support development of alternative strategies via short-term payments, and ensure accessibility of actionable data/tools for determining whether or not a procedure is necessary and tracking outcomes; share savings with provider groups.
• Accelerate development of value-based payment models; engage consumers by adopting value-based insurance design principles that deter use of low-value care and reduce barriers to necessary care.
• “It is important to encourage high-value care, while stressing the importance of reducing low-value care, to build trust with patients, and center conversations around the benefits and harms for individual patients,” said Sorenson.

Policymakers

• Create opportunities for providers, health systems, and payers to pilot innovative models that reduce low-value care.
• CMS should work with health care providers and payers to assess effective telehealth and other alternative care pathways employed during the pandemic.

“Part of the challenge of reducing low-value care to date is that we lack sufficient evidence on what are the most important drivers of its use and the benefits or unintended consequences of reducing or eliminating it. The pandemic provides a natural experiment to better understand these drivers and the short and long-term impacts of eliminating low value care on health outcomes, quality of care, and costs,” said Sorenson. This information will help empower stakeholders to develop strategies to more effectively tackle low-value care and shift those wasted resources towards high-value care for patients, building stronger public health prevention capabilities, and addressing health disparities and systemic inequalities.