Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care
The upheaval in the provision of routine health care caused by the Covid-19 pandemic offers an unprecedented opportunity to reduce low-value care significantly with concurrent efforts from providers and health systems, payers, policymakers, employers, and patients.
The Covid-19 pandemic has disrupted the provision of routine care, forcing providers and patients to postpone many services and adopt virtual and non-contact strategies. These changes present an unprecedented opportunity to re-evaluate the necessity of services our health system provides, embracing and enhancing the ones that provide the most value and finally reducing or eliminating those that provide little or no benefit. Immediate action is essential as reopening occurs; force of habit and financial stresses may otherwise counteract some positive recent changes and move the health care system back toward business as usual. We suggest aligned strategies for providers and health systems, payers, policymakers, employers, and patients that can help seize this opportunity to build a better health system.
In just months, the coronavirus (Covid-19) pandemic upended significant portions of health care system. Postponed elective procedures and services for non-emergency care significantly reduced overall health care utilization, and the rapid shift to telehealth dramatically altered care delivery. Recent months have also exposed long-standing flaws of our health care system, marked by fragmentation, inefficiencies, high rates of chronic illness, and glaring health disparities.
Reopening offers a critical opportunity to create a “new normal” — one that not only considers the continuing health and economic realities of Covid-19, but also reflects the insights and best practices gained during the pandemic
Reopening offers a critical opportunity to create a “new normal” — one that not only considers the continuing health and economic realities of Covid-19, but also reflects the insights and best practices gained during the pandemic to achieve better population health and a system that is more resilient, coordinated, equitable, and sustainable. The speed at which providers and health systems have responded to the pandemic shows that our often-lumbering health care system can in fact make swift, innovative payment and care delivery changes. There is no reason to go back to the system we had before, and this is an ideal time to build something better. But the window is already closing. In-person care has rebounded — outpatient care visits in June were about 11% lower than the baseline level, compared to 58% lower in March.2 Without continued momentum, organizations risk reverting to “business as usual,” especially with so many health care providers under intense financial strain from lost fee-for-service revenues.
One key focus area for reopening should be identifying and reducing low-value care: medical services that provide little to no clinical benefit or may cause harm to patients, such as antibiotic use for a likely uncomplicated viral infection or imaging for non-specific low-back pain. Use of low-value care is pervasive, accounting for 10% to 20% of annual health spending. We should be spending this money instead on providing high-value care that benefits patients; building stronger prevention, public health, and pandemic preparedness capabilities; and, addressing health disparities and the systemic inequalities that underly them.
To date, low-value care has been stubbornly difficult to reduce, due to a complex range of barriers. However, the system-wide disruption and resource scarcity brought forth by Covid-19 has provided maybe the strongest impetus yet for rethinking how best to prioritize what and how much care to provide, to and by whom, and in which settings. Recent reopening guidance from the CDC and CMS highlights the importance of prioritizing services that most benefit patient health and reduce exposure to both Covid-19 and broader care complications.
The coming months offer a unique and critical window for providers and health systems, and the stakeholders who support and interact with them, to take short- and long-term steps to reduce waste and build a better system that prioritizes high-quality, high-value care. We discuss these steps in more detail below.