Assessing low-value health care services in the military health system

Low-value care is the provision of procedures and treatments that provide little or no benefit to patients while increasing the cost of health care. This study examined the provision of low-value care in the Military Heath System (MHS), comparing care delivered in civilian health care facilities (purchased care) to care delivered in Department of Defense-controlled health care facilities (direct care). We used 2014 TRICARE claims data to evaluate the provision of nineteen previously developed measures of low-value care, including diagnostic, screening, and monitoring tests and therapeutic procedures. Of these, six measures appeared more frequently in direct care, while eleven measures appeared more frequently in purchased care-which may reflect the outsourcing of specialist services from the former to the latter. Magnetic resonance imaging for low back pain emerged as the most common low-value service in both care environments and could represent a target for future interventions. As the MHS and the United States increasingly focus on value-based care, the identification of low-value services accompanied by efforts to reduce such inefficient practices could provide greater quality of care at a lower cost.