Unwarranted variation in healthcare leads to greater cost without better outcomes for a member’s health—but it’s not always easy to catch. For example, a procedure might appear to be high quality on the surface, but perhaps that procedure never needed to happen. Similarly, a drug that was prescribed could be low cost, but never needed to be prescribed in the first place. In other words, a provider may improve outcomes for a patient, but if a disproportionate amount of low-value care is generated, no savings will be achieved.
For Florida Blue Medicare, combatting low-value care means taking a data-driven approach to educating primary care physicians on their referral patterns.
