A Policy Approach to Reducing Low-Value Device-Based Procedure Use.

Area of Science:

• Health Policy
• Medical Devices
• Healthcare Economics

Background:

• Low-value care, particularly from medical device-based procedures, contributes to patient harm and significant healthcare expenditure.
• Aligning clinical practice with evidence is crucial for improving healthcare value and patient outcomes.

Purpose of the Study:

• To describe a novel academic-policymaker collaboration for implementing evidence-based clinical coverage policies.
• To detail a strategy for reducing low-value care associated with medical device-based procedures within a state Medicaid program.

Main Methods:

• Identification of low-value medical device-based procedures through clinical evidence review.
• Quantification of utilization and reimbursement data.
• Development and implementation of prior authorization-based policies for Louisiana's Medicaid beneficiaries.
• Utilizing a low-value device selection index and stakeholder engagement.

Main Results:

• A structured eight-step process was developed for policy implementation.
• The strategy facilitates the alignment of clinical coverage with current evidence.
• The approach has the potential to significantly decrease low-value device-based care.

Conclusions:

• This collaborative model offers a viable strategy for reducing wasteful spending and patient harm.
• Evidence-based policy implementation through prior authorization can effectively manage medical device utilization.
• The described process can be a blueprint for other states seeking to improve healthcare value.