Low-Value Health Care In Colorado Costs $140 Million In Excess Spending

By Eric Galatas, Public News Service

June 28, 2021

DENVER - Colorado could save up to $140 million annually, and reduce potential harm to patients, by minimizing so-called low-value health-care services - diagnostic tests, screenings and treatments where the risk of harm outweighs any likely benefits.

Cari Frank, vice president for communications with the Center for Improving Value in Health Care - the group behind a new report - pointed to opioid prescriptions for lower back pain as one clear example, where pain relief comes with the risk of addiction.

She said a significant share of the costs of low-value services are passed on to patients.

"Coloradans' out-of-pocket cost was about $17 million (annually)," said Frank. "Anybody receiving those low-value care services would have rather had that money in their pocketbook, especially during the downturn of the economy like we saw during COVID 19."

Researchers sifted through potentially low-value health care claims for 4.1 million patients, and found that more than one in three were for services considered to be low-value care. They also found that over half of people who got low-value services received one or more that were wasteful or likely wasteful.

Frank explained that many health care providers are simply not aware some practices come with disproportionate risks or costs.

Frank noted that every patient is different. Depending on your family history, pre-existing conditions or treatments tried in the past, she said some procedures flagged as low-value may actually be appropriate.

"And it may spit it out on the other side of the claim's algorithm as potentially unnecessary," said Frank. "But there needs to be that back and forth, and it needs to be the right thing for you as a patient. And you need to be having that conversation with your doctor."

Some health providers, through medical boards and other professional associations, have worked to identify low-value services and offer guidelines for doctors through an initiative called Choosing Wisely.

Frank said she's hopeful that the data in her group's report will be tapped by providers, insurance companies and other stakeholders to reduce health risks for patients, and help blunt the rising costs of health care.

click here. The Choosing Wisely website the American Board of Internal Medicine Low Value Care in Colorado the Center for Improving Value in Health Care 3/25/20 House Bill 21-1232, Standardized Health Benefit Plan Colorado Option, as being discussed in the 2021 regular session Colorado General Assembly

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