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VOLUME 53 | NUMBER 2 | APRIL 2018


Payer Type and LowValue Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

Objective: To compare lowvalue health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of lowvalue care.

Data Sources: 2009–2011 national Medicare and commercial insurance administrative data.

Design: We created claimsbased algorithms to measure seven Choosing Wiselyidentified lowvalue services and examined the correlation between commercial and Medicare overuse overall and at the regional level. Regression models explored associations between overuse and regional characteristics.

Methods: We created measures of early imaging for back pain, vitamin D screening, cervical cancer screening over age 65, prescription opioid use for migraines, cardiac testing in asymptomatic patients, shortinterval repeat bone densitometry (DXA), preoperative cardiac testing for lowrisk surgery, and a composite of these.

Principal Findings: Prevalence of four services was similar across the insurancedefined groups. Regional correlation between Medicare and commercial overuse was high (correlation coefficient = 0.540–0.905) for all measures. In both groups, similar regionlevel factors were associated with lowvalue care provision, especially total Medicare spending and ratio of specialists to primary care physicians.

Conclusions: Lowvalue care appears driven by factors unrelated to payer type or anticipated reimbursement. These findings suggest the influence of local practice patterns on care without meaningful discrimination by payer type.

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