Reporting Framework for Value Based Care
Learn how a provider's relative performance, or 'value', can be evaluated through three key components in an equation: quality, efficiency, and cost.
Low back pain is a common problem: more than one in four adults surveyed report having had low back pain during the past three months. Though most low back pain resolves on its own, without medical intervention, it remains one of the most common reasons for physician visits.
Imaging tests of the low back, such as plain X-rays, CT scans, or MRIs, commonly show abnormalities—even in asymptomatic people. Evidence of disk abnormalities, such as degeneration, bulging, protrusion, and annular fissure, is present in over 50% of asymptomatic people in their 30s, and in nearly 90% of people aged 60 or older.
This combination creates a situation where people who undergo imaging tests for low back pain may have abnormalities identified that are unrelated to the pain. Additional tests, consultations, drugs, therapies, and procedures—sometimes even major surgery—may cascade from the initial decision to perform imaging. All this for low back pain that may resolve on its own: what a waste!
Milliman’s MedInsight® Health Waste Calculator can identify wasteful imaging practices for low back pain, using an evidence-based algorithm to analyze claims data in order to classify imaging services as "necessary," "likely wasteful," or "wasteful." For one of our clients, a large commercial health plan, we looked at services performed in 2012. Forty-six percent of services were wasteful; 45% were likely wasteful; and only 9% were necessary. The total aggregate allowed cost for low back pain imaging was $3.3 million, of which wasteful imaging accounted for $2.0 million.
With an evidence-based and conservative approach to measuring the cost of wasteful imaging services—one that does not include the costs of the cascade of additional services—the MedInsight Health Waste Calculator identified an important opportunity to address cost and care for low back pain for our client.
For more information on how the MedInsight Health Waste Calculator can identify wasteful services, click here.
 Centers for Disease Control and Prevention (2015). Health, United States, 2015: Table 41: Severe Headache or Migraine, Low Back Pain, and Neck Pain Among Adults Aged 18 and Over, by Selected Characteristics: United States, Selected Years 1997-2014. Retrieved December 2, 2016, from http://www.cdc.gov/nchs/data/hus/2015/041.pdf.
 Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2012 State and National Summary Tables: Table 11: Twenty Leading Principal Reasons for Office Visits, by Patient's Sex: United States, 2012. Retrieved December 2, 2016, from http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2012_namcs_web_tables.pdf.
 Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., et al. (April 2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173.