Share this article on:

Costs and Trends in Utilization of Low-value Services Among Older Adults With Commercial Insurance or Medicare Advantage

Carter, Elizabeth A. PhD, MPH*,†; Morin, Pamela E. MBA; Lind, Keith D. JD, MS*

doi: 10.1097/MLR.0000000000000809
Original Articles

Background: Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States.

Objectives: To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older.

Research Design: A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse.

Subjects: Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014.

Measures: Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures.

Results: The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%–39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (<1%) in commercial enrollees, and laminectomy (0.15% in 2009) and renal artery stenting in MA enrollees (0.07% in 2014). Renal artery stenting decreased by roughly 75% over the study period, the largest decrease in utilization, with ∼$30 million and $10 million in reduced spending for commercial and MA plans and enrollees, respectively. Spending on these services in 2014 totaled $317.6 million for commercial and $100.8 million for MA health plans.

Conclusions: Clinicians, researchers, and policymakers should strive to reach consensus on methods for more reliably and accurately identifying low-value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time.

*AARP Public Policy Institute, Washington, DC

OptumLabs Cambridge, MA

The authors declare no conflict of interest.

Reprints: Elizabeth A. Carter, PhD, MPH, AARP Public Policy Institute, 601 E. Street NW, Washington, DC 20049. E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.