Evaluation of Payer Policies to Reduce Low-Value Medical Device-Based Procedure Use

Area of Science:

• Health Services Research
• Health Policy
• Quality Improvement

Background:

• Low-value care, where harms or costs outweigh benefits, includes procedures like invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) for stable coronary artery disease.
• Other examples include endovascular intervention for peripheral arterial disease and sinus procedures for chronic rhinosinusitis.

Purpose of the Study:

• To evaluate the impact of evidence-based clinical coverage policies on the utilization of four specific low-value medical procedures within Louisiana's Medicaid program.

Main Methods:

• An interrupted time series analysis was employed to assess procedure use 12 months pre- and 18 months post-policy enactment.
• Utilization trends were compared against expected trends derived from pre-policy data, with colonoscopy serving as a control.

Main Results:

• No significant reduction in the use of ICA, PCI, endovascular intervention, or sinus procedures was observed following policy implementation.
• Specific monthly changes per 100,000 members were: ICA +0.65, PCI +0.15, endovascular intervention -0.01, and sinus procedures -0.23.

Conclusions:

• Enacting evidence-based policies for these four procedures did not decrease their utilization in Louisiana Medicaid.
• Multifaceted strategies, incorporating education, policymaking, and value-based coverage, are essential for improving evidence-based care in Medicaid populations.