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Pilot program will target unnecessary medical procedures

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The Virginia Center for Health Innovation (VCHI) has received a $2.2 million grant to begin a pilot program to reduce unnecessary medical tests and procedures.

Recent research has shown that these practices, called “low-value health care,” add no value in particular clinical circumstances and can lead to potential patient harm and greater expense.

Dr. Daniel Carey, Virginia’s secretary of health and human resources, announced the grant from the philanthropic group Arnold Ventures on Wednesday during the University of Michigan’s Value-Based Insurance Design Summit in Ann Arbor.

In 2012 the American Board for Internal Medicine’s “Choosing Wisely” initiative identified more than 550 tests and procedures that should be questioned by providers and patients.

VHCI used 2017 claims data for 5 million Virginians from Virginia’s All-Payer Claims Database and the Milliman MedInsight Health Waste Calculator to scrutinize 42 of these questionable procedures. The organization’s research identified 2.07 million unnecessary services costing $747 million.

“The data made it clear we needed to do much, much better,” Carey said in a statement.

In a partnership with Michigan’s VBID Center, the American Board of Internal Medicine, Virginia Health Information, and Milliman, VCHI will work with six Virginia health systems and three clinically integrated networks to reduce low-value care.

The health organizations are Ballad Health; Carilion Clinic; HCA and Virginia Care Partners; Inova and Signature Partners; Sentara and Sentara Quality Care Network; and VCU Health System.

These groups, representing more than 900 practice sites, will form a large-scale health system learning community targeting the reduction of seven low-value care measures.

Beth Bortz, president and CEO of the Virginia Center for Health Innovation, said the initiative partners will review baseline and practice-level performance data from the Milliman MedInsight Health Waste Calculator, develop system improvements based on that information and share best practices.

VCHI also will launch a task force aimed at increasing employers’ awareness of low-value health care and showing them actions they can take to make improvements.

Both the Virginia Chamber of Commerce and the Virginia Business Coalition are project partners.

“Employers are concerned with the continuously rising cost of health care and are looking for ways to ensure maximum value for their investment.  This effort, which is both data-driven and highly collaborative, is exactly the kind of partnership our members are ready to engage in,” Barry DuVal, president and CEO of the Virginia Chamber, said in a statement.

With the Arnold grant, VCHI plans to:

·         increase clinician competence in reviewing performance reports and implementing targeted interventions to improve outcomes;
·         improve understanding of which interventions are effective in reducing seven provider-driven low-value care tests and procedures and provide health systems and practice leaders throughout the country with tested best practices they can implement;
·         reduce the physical, emotional, and financial harm patients experience from unnecessary tests and procedures; and
·         educate Virginia employers (including state government) on the actions they can take to drive complementary payment reform that better incentivizes value in health care.

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