- Comparative Effectiveness
- Evidence-Based Design and Overuse
- Health Accounts and Account-Based Plans
- High-Performance Networks/Centers of Excellence
- Medical Plan Design and Administration
- On-Site Health Centers and Convenience Care Clinics
- Patient Safety and Quality
- Payment Reforms/Pay-For-Performance
- Pharmacy Plan Design
- Primary Care
- Specialty Pharmacy
- Transparency and Reference-Based Pricing
- Vendor Management
Evidence-Based Design and Overuse
Why Employers Care
Evidence-based design is a promising way to improve health care quality and reduce overuse, a top challenge for large employers in maintaining affordable benefit coverage. The Congressional Budget Office estimates that up to 30% of care delivered in the U.S. is for unnecessary tests, procedures, doctor visits, hospital stays and other services.1 Not only does excessive care compromise patient safety, it leads to an estimated $750 billion in wasted spending.2
One promising new initiative aimed at eliminating unnecessary care, while ensuring that the care delivered is appropriate and high quality is the Choosing Wisely® campaign. Led by the ABIM Foundation, Choosing Wisely® seeks "to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices." Medical specialty societies created evidence-based lists of tests or procedures that are commonly overused and whose necessity should be questioned. These lists are titled "Five Things Physicians and Patients Should Question."
Consumer Reports is the consumer communication partner for Choosing Wisely®, and is developing resources for patients and physicians to engage them in important conversations about the appropriate use of health care resources. The Business Group is working with Consumer Reports to disseminate these resources to employers, employees, and their families.
What Can Employers Do?
Employers and health plans are using evidence-based designs to:
- Support employees to make informed medical decisions;
- Improve patient safety and reduce risks associated with unnecessary procedures;
- Reduce spending on interventions shown to be driven more by provider preference and supply than by evidence of effectiveness;
- Lower net spending for chronic conditions, e.g. avoidable hospitalizations and emergency department use; and
- Direct care to best-in-class providers.
A growing number of employers differentiate employee cost sharing based on use of Centers of Excellence, high-performance networks and/or employee use of decision support tools. Procedures commonly addressed with these approaches include:
- Back surgery
- Hip replacement, knee replacement and knee arthroscopy
- Metabolic (bariatric) surgery
- Heart procedures such as PCI, PTCA, stents and CABG
- Maternity care
- Cancer care
References (show references)
1 Congressional Budget Office. Increasing the value of federal spending on health care. http://www.cbo.gov/ftpdocs/95xx/doc9563/07-16-HealthReform.1.2.shtml. Accessed September 10, 2012.
2 Institute of Medicine. Best care at lower cost: The path to continuously learning health care in America. 2012. Washington, DC: The National Academies Press.
Page last updated: September 12, 2012