Targeting Overuse, Misuse and Underuse in Cardiovascular Care: Why Health Plans Need a Comprehensive Strategy

Cardiology spending is projected to increase by 25 percent every five years, reaching $750 billion by 2035. This growing burden on our health care system is driven by numerous factors, such as the aging of the population and the burden of heart disease. Yet a major portion can be pegged to inappropriate use.

Traditionally, health plans' dominant strategy to prevent inappropriate use in cardiovascular care has involved denying requested services via utilization management. However, such a one-dimensional approach misses large opportunities to improve care and control spending. Few plans, for example, take proactive steps to increase adoption of low-cost, high-value services that can avoid downstream hospitalizations, procedures and other costly services.

To be most effective, plans need multifaceted strategies to target three distinct challenges—overuse, misuse, and underuse.

Read this insight brief to:

• Learn what constitutes overuse, misuse and underuse, and how frequently each occurs in cardiovascular care.
• Read clinical examples demonstrating how each of these three problems can result in lower quality care and/or higher spending.
• Discover key strategies of a comprehensive cardiovascular care management program that tackles each of these challenges.

About the Author

Dr. Fernando Villacian is Senior Medical Director, Cardiovascular at New Century Health. As an interventional cardiologist and managed health care executive, he is responsible for the advancement of technology-based cardiology solutions that enhance quality of care delivery and reduce variation in treatment. Dr. Villacian has four decades of health care experience and has been with NCH since 2008.

Follow on Linkedin More Content by Fernando Villacian, MD, FACC