The concept of value-based care, meaning providing high quality care at the lowest cost, has become central for improving the health of populations. Yet high-value care is constantly battling low-value care—meaning unnecessary tests or services that can be expensive and not contribute to improving the health of our patients/populations. We hear this all the time in regard to the health care crisis in this country, and the rising amount of gross national product that is used to pay for that care in adults. But what about children? To what degree are we practicing low-value care in our patients? Chua et al. (10.1542/peds.2019-2325) conducted a cross-sectional analysis of both Medicaid and privately insured claims databases from 2013-2014 in 12 states. The authors looked at 20 measures of low-value care involving diagnostic testing, imaging, and prescription drug use to see if low-value care was more common in public vs privately insured children or vice-versa. The authors included close to 7 million Medicaid-enrolled children and just over 1.6 million privately insured children and found that both groups reported similar rates of low value care tests and services, with low-value prescription drug use being the most frequent flyer followed by diagnostic tests, and last but still showing low-value behaviors—imaging tests. While there was no difference by source of health insurance, the authors did uncover differences in low-value practice by state.
What can be done about the statewide variation seen? The authors prove that low-value care is independent of how health care is paid for, so the onus needs to be at the population or health-system level if we are going to remedy this situation. How might we do that? We asked Dr. Gerry Fairbrother from University of New Mexico and Lisa Simpson, President and CEO of AcademyHealth in Washington DC (10.1542/peds.2019-3414) to provide us with a commentary that is chock full of great suggestions and ideas to reduce the amount of low-value care being practiced on children. With approximately 10% of the children in this 12-state study receiving at least one low-value test, imaging study, or drug, there is high-value in reading both this article and accompanying commentary and then applying the findings to your own practice and state-wide health care system if we are going to further reduce rather than increase the low-value care practices in our pediatric patients. The price is right for linking to this study and commentary to learn more.