Costs and Trends in Utilization of Low-value Services Among Older Adults With Commercial Insurance or Medicare Advantage
Bibliographic Data
| ID | 9102191 |
|---|---|
| Authors | Elizabeth A Carter (0000-0001-6318-7771, AARP Public Policy Institute, Washington, DC, corresponding author), Pamela E Morin (OptumLabs Cambridge, MA), Pamela Morin (Optum (United States)), Keith D Lind (AARP Public Policy Institute, Washington, DC), Keith Lind (Public Policy Institute of California, corresponding author) |
| Year | 2017 |
| Volume | 55 |
| Issue | 11 |
| Pages | 931-939 |
| Publication date | 2017-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000809 |
| PMID | 28930892 |
| OpenAlex | W2754380287 |
| Language | EN |
| Citations received | 3 |
| References cited | 34 |
BACKGROUND: Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. OBJECTIVES: To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. RESEARCH DESIGN: A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse. SUBJECTS: Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014. MEASURES: Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures. RESULTS: The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%-39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (<1%) in commercial enrollees, and laminectomy (0.15% in 2009) and renal artery stenting in MA enrollees (0.07% in 2014). Renal artery stenting decreased by roughly 75% over the study period, the largest decrease in utilization, with ∼$30 million and $10 million in reduced spending for commercial and MA plans and enrollees, respectively. Spending on these services in 2014 totaled $317.6 million for commercial and $100.8 million for MA health plans. CONCLUSIONS: Clinicians, researchers, and policymakers should strive to reach consensus on methods for more reliably and accurately identifying low-value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time
Actuarial science · Business · Family medicine · Health care · Health economics · Medicaid · Medicare Advantage · Public health · Economic and Financial Impacts of Cancer · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Medicine · Nursing
| Unique citing works | 3 |
|---|---|
| Citations per year | 0,43 |
| Citation span | 2019 - 2022 (4) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 3 |