Reducing Low-Value Care Key to Value-Based Reimbursement Success

RevCycle Intelligence (02/01/18) Belliveau, Jacqueline

Cedars-Sinai Medical Center, a nonprofit, academic health system in the Los Angeles area, is working to reduce low-value care use among its providers and across low- to high-risk patient populations. The health system is using clinical decision support tools to help achieve its goals. As low-value care use falls, Cedars-Sinai is finding that its patients are experiencing improved care delivery and, as a result, costs are declining. Scott Weingarten, MD, MPH, senior vice president and chief clinical transformation officer at Cedars-Sinai Medical Center, explains: "What we do is integrate information defining low-value care into electronic health records as clinical decision support. We remind providers when they're about to do something or order a test or treatment which the sub-specialty societies or peer-reviewed literature would suggest is low-value care." From that point, providers can make their own decisions based on the evidence in the reminder as well as the patient in front of them. The reminder also signals for the provider to discuss alternative treatment options with the patient. Additionally, Cedars-Sinai aims to reduce low-value care by giving providers feedback on their low-value care use in comparison to their colleagues. Since the health system started targeting low-value care four years ago, Weingarten says providers have started to better understand how the care they provide affects value. "But more importantly, we can observe an educational effect," he notes. "The provider knows if they order low-value care that they're going get an alert, and if it pops up enough times, they know they're going get feedback. If they agree with the evidence and the sub-specialty physician guidelines, you see the frequency of ordering low-value tests and treatment decrease."

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