Overuse and misuse of health care services are two of the biggest problems affecting the quality and cost of care.
Health care purchasers in several states have implemented well-established and successful initiatives to reduce misuse and overuse of care. In Washington state, such efforts have resulted in a 94 percent reduction in bariatric surgery spending and a $10 million reduction in enteral nutrition spending.
This brief by Bailit Health Purchasing focuses on actions state purchasers can take with contracted plans, providers, and other engaged purchasers to reduce misuse and overuse of health care services.
Such strategies include:
- Developing a communications strategy to ensure problems of overuse and misuse are being discussed by state leaders.
- Coordinating efforts with other large health care purchasers.
- Supporting the efforts of external experts to identify overused and misused services.
- Introducing evidence-based concepts into policies, regulations, and statutes.
- Introducing value-based insurance designs that encourage members to utilized high-value services.
With overuse estimated to affect 30 percent of health care services, there is opportunity for purchasers, plans, and providers to work together to reduce the amount of overused and misused health care services being delivered to patients.