Identification and Quantification of Low Value Care for chronic-obstructive pulmonary disease (COPD) and coronary heart disease (CHD) using anonomyzed Swiss claims data

Project description

Low-Value Care is defined as services that in an individual context (a) provide little or no benefit to patients, (b) potentially cause harm, (c) incur unnecessary costs, and/or (d) do not use scarce health care resources in a benefit-oriented manner compared to the use of alternative services or the use in an alternative patient group. The systematic identification and quantification of Low-Value Care is challenging. Insurance invoice data have not been used for this purpose so far. The study aims to examine parts of the care path of two exemplary service areas for Low-Value Care with the help of insurance data. 

Two chronic diseases were chosen because of their importance for the health care system and the suffering of patients: chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD). In COPD, patients' medication adherence was investigated and it was found that regular medication use can reduce the risk of exacerbation including hospitalisation by more than 50%. In CHD, it has been shown that a much larger proportion of patients could first receive a coronary CT instead of an invasive coronary angiography (cardiac catheterisation) for initial diagnosis with the same diagnostic result. This could save approximately CHF 4.5 to 5.5 million per year for Groupe Mutuel policyholders.

From the results of the study it can be concluded: (1) Low-Value Care can be identified and quantified using billing data, (2) Low-Value Care in COPD could be reduced through structured treatment programmes and digital health applications, and (3) quality-oriented reimbursement incentives could have the effect of ensuring that scarce resources are used in a targeted and efficient manner. Furthermore, it has been shown that a more comprehensive database, especially diagnostic information, would substantially strengthen the possibilities and significance of the analyses.

Project team

Anja BischofJohannes CordierDr. Justus VogelProf. Dr. Alexander Geissler

Cooperation partner

Groupe Mutuel Services AG

Funding source

Groupe Mutuel Services AG