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      Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care

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          Abstract

          The upheaval in the provision of routine health care caused by the Covid-19 pandemic offers an unprecedented opportunity to reduce low-value care significantly with concurrent efforts from providers and health systems, payers, policymakers, employers, and patients.

          Summary

          The Covid-19 pandemic has disrupted the provision of routine care, forcing providers and patients to postpone many services and adopt virtual and non-contact strategies. These changes present an unprecedented opportunity to re-evaluate the necessity of services our health system provides, embracing and enhancing the ones that provide the most value and finally reducing or eliminating those that provide little or no benefit. Immediate action is essential as reopening occurs; force of habit and financial stresses may otherwise counteract some positive recent changes and move the health care system back toward business as usual. We suggest aligned strategies for providers and health systems, payers, policymakers, employers, and patients that can help seize this opportunity to build a better health system.

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          Most cited references12

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          Waste in the US Health Care System

          The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste. Despite efforts to reduce overtreatment, improve care, and address overpayment, it is likely that substantial waste in US health care spending remains.
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            Patient-centered care is associated with decreased health care utilization.

            This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization. Five hundred nine new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were their use of medical services and related charges monitored over 1 year. Controlling for patient sex, age, education, income, self-reported health status, and health risk behaviors (obesity, alcohol abuse, and smoking), a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care (P = .0209), less frequent hospitalizations (P = .0033), and fewer laboratory and diagnostic tests (P = .0027). Total medical charges for the 1-year study were also significantly reduced (P = .0002), as were charges for specialty care clinic visits (P = .0005), for all patients who had a greater average amount of patient-centered visits during that same time period. For female patients, the regression equation predicted 15.47% of the variation in total annual medical charges compared with male patients, for whom 31.18% of the variation was explained by the average percent of patient-centered care, controlling for sociodemographic variables, health status, and health risk behaviors. Patient-centered care was associated with decreased utilization of health care services and lower total annual charges. Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered.
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              Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID-19 Pandemic

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                Author and article information

                Contributors
                Journal
                NEJM Catal Innov Care Deliv
                NEJM Catal Innov Care Deliv
                cat-non-issue
                Nejm Catalyst Innovations in Care Delivery
                Massachusetts Medical Society
                2642-0007
                21 August 2020
                : 10.1056/CAT.20.0368
                Affiliations
                [1]Assistant Professor in Population Health Sciences and Public Policy, Population Health Sciences and Duke-Margolis Center for Health Policy;
                [2]Research Associate, Duke-Margolis Center for Health Policy, Duke University;
                [3]Research Assistant, Duke-Margolis Center for Health Policy, Duke University;
                [4]Director and Robert J. Margolis M.D. Professor of Business, Medicine and Policy, Duke-Margolis Center for Health Policy, Duke University;
                Author information
                https://orcid.org/0000-0002-5341-2960
                Article
                CAT.20.0368
                10.1056/CAT.20.0368
                7442284
                3954ca52-3c07-4fdb-a715-cfd80c89b659
                Copyright ©2020 Massachusetts Medical Society.

                This article is made available via the PMC Open Access Subset for unrestricted re-use, except commercial resale, and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the Covid-19 pandemic or until revoked in writing. Upon expiration of these permissions, PMC is granted a license to make this article available via PMC and Europe PMC, subject to existing copyright protections.

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