The U.S. health care system is facing a major challenge of high and growing health care costs. It has been estimated that the country spends $226 billion annually on low-value medical services that provide very little or no patient benefit. Thus, reducing the incidence of such low-value medical care is a major policy priority. Although recent cost containment policies have focused on incentives for provider organizations, little is known about the relationship between provider organizations and overuse. In addition, while many quality measures have been developed to assess underuse in administrative data, few such measures assess overuse. The overall aim of this project is to use novel direct measures of overuse in order to understand provider organizations'role in the delivery of low-value care. The proposed research will involve highly specific measures of low-value services that the principal investigator and collaborators have developed based on published evidence-based lists of low-value services. These measures will be applied to Medicare claims data, which, along with physician group practice data, will be used to test several hypotheses related to the role of provider organizations in low-value care delivery. Statistical analyses will assess pattern of low-value care within organizations (i.e. correlations across different services, persistence of service use over time, cohesion of physician behavior changes) and across organizations (i.e. organizational factors associated with low-value service delivery). This project will be conducted by an MD/PhD graduate student studying the economics of health care policy.

Public Health Relevance

Given the challenges faced by high and rising health care costs, a major policy priority is to reduce the utilization of medical care that provides very litte or no benefit to patients. The proposed research will contribute to this goal by applying new measures of such medical care to insurance claims data and assessing the role of provider organizations in the delivery of low-value services. This project will inform policy efforts that am to improve public health by directing health care resources toward more beneficial medical care.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
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Special Emphasis Panel (ZRG1)
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Bhattacharyya, Partha
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Harvard Medical School
Schools of Medicine
United States
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Schwartz, Aaron L; Zaslavsky, Alan M; Landon, Bruce E et al. (2018) Low-Value Service Use in Provider Organizations. Health Serv Res 53:87-119
Chua, Kao-Ping; Schwartz, Aaron L; Volerman, Anna et al. (2016) Use of Low-Value Pediatric Services Among the Commercially Insured. Pediatrics 138:
Charlesworth, Christina J; Meath, Thomas H A; Schwartz, Aaron L et al. (2016) Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations. JAMA Intern Med 176:998-1004
McWilliams, J Michael; Hatfield, Laura A; Chernew, Michael E et al. (2016) Early Performance of Accountable Care Organizations in Medicare. N Engl J Med 374:2357-66
Schwartz, Aaron L; Chernew, Michael E; Landon, Bruce E et al. (2015) Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program. JAMA Intern Med 175:1815-25
McWilliams, J Michael; Chernew, Michael E; Landon, Bruce E et al. (2015) Performance differences in year 1 of pioneer accountable care organizations. N Engl J Med 372:1927-36
Scott, John W; Sommers, Benjamin D; Tsai, Thomas C et al. (2015) Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients. Health Aff (Millwood) 34:125-33
Scott, John W; Schwartz, Aaron L; Gates, Jonathan D et al. (2014) Choosing wisely for syncope: low-value carotid ultrasound use. J Am Heart Assoc 3: