RowdMap, is honored to have Chief Scientific Officer, Joshua Rosenthal, PhD, spotlighted by AcademyHealth and the ABIM, the Foundation behind the Choosing Wisely Initiative, as a featured member of the Research Community on Low-Value Care (RC-LVC).
Once confined to the depths of academic circles, Low-Value Care is having a moment. Decades of research on unwarranted variation, notably driven by the Dartmouth Atlas, is meeting invigorated market interest. Payers are increasingly interested in mitigating 30 cents of every dollar that care that does not produce better outcomes than lower risk, lower intensity, and lower cost options. Providers are increasingly interested in capturing the value of their high-value care. Consumers in getting the right care, not only to prevent unnecessary and unintended consequences, but also to keep the money in their pockets (on average, $4500 for each household goes to low-value care, money that could be spent on food, clothing, shelter and education).
Renewed market, policy, and social and public interest has been met with a variety of media attention, but also research groups and initiatives from various groups to address low-value care, its definitions, its clinical protocols and its practical application. AcademyHealth recently founded the Research Community on Low-Value Care (RC-LVC) to address the subject: http://bit.ly/AH-LVC
The AH-LVC defines the mission and efforts as follows:
“The problem of overuse, unnecessary care, or low-value care is increasingly a focus of the national health policy conversation. Estimates suggest that as much as one-third of health care spending in the United States is of low-value or wasted. Many factors contribute to the problem, including increased patient demand, information asymmetry, perverse financial incentives for providers, and a culture of “more is better than less.” AcademyHealth and the ABIM Foundation established a partnership in 2014 to assess the current landscape of research on this issue.
The partnership then focused on priorities for studies of interventions to reduce low value care and shared these with multiple research funders. From these initial efforts, the partnership has developed a learning community with diverse stakeholders to enhance collaboration on low-value care research. Based on the experiences to date, the partnership is now establishing priorities for patient-centered measures on low-value care as a key tool to future research and interventions to reduce low value care.”
RowdMap, Chief Scientific Officer, Joshua Rosenthal, PhD, is a member of the group and was recently featured in an interview below:
Member Spotlight Corner: Learn what members of the RC-LVC are working on!
Joshua Rosenthal, PhD, Co-Founder & Chief Science Officer, RowdMap, Inc.
What interests you about low-value care research?
In a field full of perverse incentives, rarely in healthcare do you have the opportunity to create market value by doing the right thing. Myself and my co-founders at RowdMap are Ernst and Young Entrepreneur of the Years, and I’ve given guest lectures at Harvard, Hopkins and MIT for years to MD, MPH, Comp Sci and MBA students, half interested in getting into healthcare to contribute to public and social good, half interested in coming up with the next big thing with dreams of seeing themselves on Shark Tank. The truth is, to have meaningful impact you have to do both, you have to create public good by delivering market value, working in a delivery system, with often perversely-incentivized parties that divergent and even antithetical interests with one another. The “next big thing” is not a cool app coming from silicon value, but business to business services with payers and providers delivering high-value care and impacting the lives of those most at risk that feel the effects the most acutely, folks in fly-over country in the “unglamourous,” “unsexy” in government programs and low-income and individual commercial products. If you can identify, quantify and reduce low-value care, you free up resources for the population and free up finances to adequately compensate risk-owners, physicians and providers, and positively impact members and patients. The beauty of the opportunity is using market forces to accomplish a social good, essentially unwinding decades of an economic model that created not only variation but artificial demand for care. For more detail, color commentary and explanation, click here to listen to a recent episode from the Public Interest Podcast.
Could you tell us a little about the low-value care projects you are working on right now?
As a business RowdMap, Inc. helps payers and providers reduce low-value care, and capture the value they create from delivering high-value care. We work in 49 states covering 100MM patients and members across all lines of business with payers (large/small group commercial, individual, Medicare, Medicaid, Military and other government programs) and with providers of all types (leading academic medical centers, traditional hospital-based systems, Primary-Care based systems, Orthopedic systems, Cardiology systems). With payers it’s about reducing medical expense by reducing low-value care, through network design, pricing and financial design, operations and provider partnership. Low-value care typical represents about 30% of their overall expense, so even relatively modest impact has massive financial yield, and frees up payers to invest in provider payment, product design and growth efforts. On the provider side, it’s about accessing revenue, specifically diversifying revenue that is at risk from low-value care (by lines of service, individual physicians and even specific treatments), growing protected revenue that is safe in both Fee for Service and Value-Based Models, and capturing revenue from High-Value Care through either programs or specific payment arrangements with private payers. There’s information, white-papers, articles, and presentations on the site.
As side projects, I’ve co-written white papers with the Health Care Transformation Task Force, which includes leading payers (Aetna, HCSC, BCBS Michigan, BCBS Massachusetts, etc.) and providers (Trinity, Ascension, Dartmouth-Hitchcock, SSM), which address low-value care, specifically recommending CMS and private payers and delivery systems 1) measure the success of value-based care against the criteria of low-value care; 2) compensate physicians and providers based on their practice patterns around low-value care; 3) use public data and benchmarks for identifying low-value care, observational intensity bias, and the geographic context of supply vs. demand for population health.
Another side project includes working with the Data Access and Use subcommittee on the NCHVS (National Committee on Health Vital Statistics, the congressionally mandated public advisory body for the Secretary of Health and Human Services) to not only build tools and resources to support, but also to showcase the impact of public data for community health as well as creating value in the marketplace, specifically by identifying, quantifying and reducing low-value care.
What areas of low-value care research can members of the community connect with you on?
I’m particularly interested in the practical application of reducing low-value care and delivering high-value care. In a complex system how does an organization actually affect change? High-value care sounds great, until as a provider system executive you are faced with your hospital’s CEO receiving a bonus based on how many beds are booked. Reducing low-value care sounds admirable, until as a resident you discover you are almost required to admit populations with specific social determinants through the ER with full work ups you do not believe are necessary. The demoralizing part often comes when as a payer when despite your best efforts your actuaries can’t account for 30% of your spend event with utilization reviews and unit cost analysis. I’m particularly interested in the tips, tricks, and techniques around the business reality of the delivery system and the tactical applications for compensating delivery. A huge part of that interest is around the cultural component of managing this change, something in which leaders in the healthcare vertical is woefully behind other sectors. Leemore Dafney and Thomas Lee have a great description in a recent Harvard Business Review: “Finally, health care has suffered from a simple know-how problem. In the absence of financial incentives to pursue value and without good data to guide leadership, the management skills necessary for transforming care delivery have not developed. Health care leaders have not learned how to achieve consensus quickly, overcome cultural resistance to change, or nurture high-performing teams. They have not mastered the principles of lean management or high-reliability cultures. And they have not gained experience in making tough, data-driven strategic choices in the face of powerful resistance, such as when and where to cut services in order to improve efficiency.” All of that is key to reducing low-value care and I’m particularly interested in connecting with folks on that front.
What do you hope to get out of being a part of this research community?
The team RowdMap includes David Wennberg, Steve Ondra, and other icons in the field and a team that has spent decades working in not only the research around low-value care, but also the ins and outs of affecting change in the marketplace by working with actors in the delivery system. That academic definitions and methods for quantifying and identifying low-value care are important, but I’m personally most interested in the best practices, success stories, challenges and failures around how real world actors implement ways to reduce low-value care in the market place. How does one motivate, compensate, align, empower and essentially do the hard work of practical application. We have brought together a business-oriented working-group of physicians, providers and payers from across the country that meets to address the practical applications of delivering high-value care and I’m interested in seeing if this research group interacts with the broader marketplace and how it might intersect with actual delivery at scale.
Can you tell us a fun fact about yourself?
On my Fulbright at the Sorbonne’s interdisciplinary think-tank, I used to run seminars with anthropologists, economists, CERN particle physicists, etc. but the most difficult and most fulfilling teaching I ever did was special/exception education in public elementary schools.