Solving the healthcare waste problem

By Dr. David Buchholz
Wednesday, July 18, 2018

Video: Drs. Mia Wise and David Buchholz, both medical directors at Premera Blue Cross, appear on King 5's New Day Northwest to share about the important finds in the Washington Health Alliance's new report. Video courtesy of King 5.

“I often get the care I don’t need” is dramatically documented in the Washington Health Alliance’s (WHA) newest report. Based on 2016 data, the report found that 11 overused healthcare services cost close to $300 million.

It’s a loud, and expensive, wake-up call. A few examples:

  • Too frequent cervical cancer screening in women (pap smears)
  • Imaging for low back pain and headaches
  • Baseline lab studies before low-risk surgeries on low-risk patients

Waste in healthcare

Medical tests, procedures, and treatments that don’t help and might harm patients based on their health situation are known as low-value care, overtreatment, and overuse. This is what many describe as waste in healthcare.

While we think of waste in dollars, it’s actually a broader issue.

Waste occurs on many levels. It can mean extra costs for patients because one wasteful test often includes follow-up tests and treatments. It’s also time spent in appointments that aren’t needed and energy spent on worrying.

Case in point

People think that waste in healthcare only happens with expensive testing. The WHA report revealed this isn’t always the case. Many wasteful healthcare services were low-cost (under $500).

Cervical cancer screenings, or pap smears, are an example. Pap smears aren’t expensive, but since they’re sometimes inappropriately done more often than recommended, these costs add up. Pap smears that are done too frequently may result in another pap smear or a more invasive and expensive procedure to follow-up on something seen in the results.

Most women expect to receive this test at their annual wellness exam.  However, the current cervical cancer screening guidelines: with normal test results, healthy women between age 21-30 need pap smears every 3 years. And, depending on the specifics of the test, up to every 5 years between ages 30-65.         

What you can do

Premera’s medical directors are sharing data from the WHA with our providers to help them improve and reduce healthcare waste. This report is another way that transparent data allows payers and providers to partner to make healthcare work better.

As healthcare consumers, we also need to have informed conversations with our healthcare providers. Before you have that next test or procedure, ask these questions:

  • Do I really need this test or procedure?
  • What are the risks and side effects?
  • Are there simpler, safer options?
  • What happens if I don’t do anything?
  • How much will this cost, and will my insurance pay for it?

You can also use our shared decision making tools to help you prepare for your next appointment.  

Dr. David Buchholz is a medical director in Collaborative Healthcare Solutions.

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