SCV

With support from Arnold Ventures, the Virginia Center for Health Innovation launched a statewide pilot in March 2019 to reduce the provision of low value health care in Virginia. 

Low value health care includes medical tests and procedures that research has proven add no value in particular clinical circumstances and can lead to potential patient harm and a higher total cost of care.

Project Overview

Smarter Care Virginia is aligned with Aim I (reducing low-value care) of VCHI’s Health Value Dashboard. The project will utilize a two-part strategy to drive a significant reduction in seven provider-driven low value care tests and procedures. Over three years, we will focus specifically on producing a 25 percent relative reduction in seven low-value care measures that are provider-driven while also prioritizing up to six consumer-driven measures for our next phase of work.

VCHI has partnered with the leadership of six Virginia health systems and three clinically integrated networks on this project: Ballad Health; Carilion Clinic; HCA and Virginia Care Partners; Inova and Signature Partners; Sentara and Sentara Quality Care Network; and VCU Health System.

In addition, a complimentary employer task force will serve to increase employer knowledge of low-value health care, expose Virginia employers to employers that are mobilizing for improvement, and engage employers in action they can take in employee communications, benefit design, and contracting to drive sustainable improvement.

Measures

"Drop the Pre-Op"

  • Don't obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss or fluid shifts is/are expected to be minimal
  • Don't obtain baseline diagnostic cardiac testing (trans-thoracic /esphophageal echocardiography) or cardiac stress testing in asymptomatic stable patients with known cardiac disease (ie. CAD, valvular disease) undergoing low or moderate risk non-cardiac surgery
  • Don't obtain EKG, chest x-rays or pulmonary function test in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery

Treatment & Screening

  • Don't order annual electrocardiograms or any other cardiac screening for low-risk patients without symptoms
  • Don't perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present
  • Don't routinely order imaging tests for patients without symptoms or signs of significant eye disease
  • Don't place peripherally inserted central catheters (PICC) in stage III-V CKD patients without consulting nephrology

Consumer-Driven Measures

The consumer-driven measures will be selected by the Smarter Care Virginia Employer Task Force and included in the Employer Action Plan of the Virginia Plan to Improve Health Value.

Clinical Learning Community Partners

SCV Clinical Partners
Employer Task Force on Low Value Care

The Smarter Care Virginia Employer Task Force will work to increase employer knowledge concerning the challenge of low-value health care, expose Virginia employers to employers that are mobilizing for improvement, and engage employers in specific actions they can take in employee communications, benefit design, and contracting to drive improvement.

Both public and private employers are uniquely positioned to help reduce low-value and unnecessary services. Through benefit design and employee communications, employers can to drive change by helping employees become advocates for their own health by seeking appropriate care. As purchasers of health services, employers can leverage policies and contracts to ensure benefits are designed to reduce low-value care and support high-value care.

Task Force Members

Robert Blue | co-Chair

Executive Vice President and President & CEO - Power Delivery Group

Dominion Energy

daniel carey, md | Co-Chair

Secretary, Health and Human Resources

Commonwealth of Virginia

Chris Beckford

President & CEO

eTRANSERVICES

Doug Bish

Associate Professor, Industrial and Systems Engineering

Virginia Tech

Carlos Del Toro

President & CEO

SBG Technology Solutions

Emily Elliott

Director, Dept Human Resource Management

Commonwealth of Virginia

Wina Giddens

Director, Benefits & HRIS

The Port of Virginia

farrell hanzaker

CFO

Virginia beach city public schools

Dean Lynch

Executive Director

Virginia Association of Counties

Andy Mann

Compensation and Benefits Manager

The Luck Companies

Clayton Medford

VP, Government Affairs

Northern Virginia Chamber

Starr Oliver

SEVP, Chief Marketing & HR Officer

TowneBank

Nicole Riley

Virginia State Director

NFIB

Lisa Swaney

Chief Human Resource Officer

Smithfield Foods

Meredith Touchstone

Director, Benefits

Carmax

Matthew Turner

VP, Global Total Rewards, HRIS, and People Analytics

Genworth

Lisa Woods

Senior Director Strategy & Design, US Benefits

Wal-Mart Stores