Addressing skyrocketing health care costs is a top priority for most employers. But cutting those costs isn’t simple, and there isn’t an easy fix. One way BlueCross BlueShield of South Carolina seeks to curb those costs is to cut down on waste or low-value care — unnecessary tests and procedures. 

“Reducing waste in the system, in health care in general, is probably one of the most important things we can do in terms of ensuring patients get the right care at the right time for the right cost,” says Dr. Matt Bartels, chief medical officer. 

Providers, patients, insurers and employers will need to partner in the effort to reduce low-value care.  

About 550 recommendations from physicians, as well as other materials to help jump-start conversations between doctors and patients, have been compiled into Choosing Wisely, a website with resources for both parties to find ways to improve care, from the American Board of Internal Medicine Foundation (ABIM)*. 

These recommendations include suggestions such as not ordering imaging for low back pain the first six weeks unless there are signs of a serious problem. Or not routinely prescribing antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen. 

“What we want to encourage is more conversations between the providers and their patients so their patients can be part of the decision-making process,” Bartels says.  

This effort isn’t just about added costs and redundancies. Unnecessary procedures and tests can lead to incidental findings, unintended consequences and subsequent testing — and then more costs. Sometimes the low-value services compound, and there are real patient safety aspects to be considered. More care can be dangerous — as in the case of increased exposure to radiation through duplicative X-rays. 

“We are trying to change the perception that more care is better care. It’s really about the right care,” he says. 

This effort is centered on education — helping patients better understand their own health care decisions and empowering them to become active participants in those choices. Sometimes patients rely on the expertise of physicians to tell them what the course of action should be. This effort, according to Bartels, is about changing that dynamic to support patients as better consumers of the care they receive.  
 
“These efforts are also about empowering individuals with information and helping everyone involved in the health care continuum become more informed about those things that add value and those things that don’t add value in terms of contributing to better outcomes,” Bartels says.  

Data suggests that physicians agree. In a survey from ABIM Foundation, 75 percent of physicians believe unnecessary care is a serious problem and 69 percent say the average physician orders useless tests and procedures at least once a week. That’s why it is especially meaningful that doctors are leading the Choosing Wisely effort with suggestions coming from national health organizations like American Academy of Pediatrics* and the American Academy of Family Physicians*. 

“The fact that physicians and other health care professionals have taken the lead on this is really powerful,” he says.   

BlueCross is partnering with providers to leverage data-based insights to reflect where there might be opportunities to deliver services in a more efficient way. 

“We want to form strong partnerships with the providers because they are the ones who deliver care. And we want to educate our members to ask well-informed questions of their doctors,” he says. 

Employer partners are also important in the effort to drive down low-value care. Employers who are interested in ensuring that their employees get appropriate care in the right setting and at the right time can help reach their employees. 

The Choosing Wisely website provides a starting point for patients to learn the questions they should be asking their physicians, sorted by specialty and service area. 

With help from providers, employers and members, this effort can be meaningful in reducing costs. 

“I am optimistic that we can have an impact collectively in South Carolina and beyond by working on this important topic of low-value services together,” Bartels says. “This is going to be a long journey for everyone, and the more we can be transparent and collaborative, the better it will ultimately be for the patients.”

*These are an independent organizations that offer health information that members of BlueCross may find helpful.

Oct. 16, 2019