Reduce unnecessary tests with member data

Getting to know your members better can reduce overuse and save your plan money


A hospital performs a low-value test or procedure every minute and a half, according to a report from the Lown Institute. These services have little impact on patient health, and are unnecessary costs. 

Overuse may seem like a problem primarily at the hospital level. But health plans can also make an impact on reducing unnecessary tests and overspending.

What is overuse?

Overuse refers to the delivery of tests and procedures that:

  • Provide little or no clinical benefit
  • Are unlikely to have an impact on clinician decisions
  • Increase health care spending without improving health outcomes, or 
  • Risk patient harm that outweighs potential benefits

Why avoid overuse?

These services are unnecessary expenses in themselves. But overuse also exposes patients to complication risks. Risks could include hospital-associated infections (HAIs) or other conditions that lead to readmissions.

How can health plans avoid overuse and overspending?

To identify where overuse is happening, care teams need to communicate frequently and clearly. That could mean using technology that enables accurate and consistent information sharing.

Besides hospital-wide measures, health plans can also encourage care team communication with members. Using member data is one way that health plans can impact overuse by directing members to preventative or higher-value care. 

Secure messaging

Digital Care Management (DCM) solutions can connect care teams with members through secure 1:1 messaging. Members can ask their care manager or advocate about a test or procedure, and alert them if they’ve done it before. Similarly, care managers can discuss concerns with members to help them understand their health and benefits options and guide them to in-network providers. The right provider will listen to member concerns, and are less likely to recommend unnecessary tests.

Intake assessments

The right DCM tool can also offer members an intake assessment. This survey uncovers current healthcare needs, such as chronic conditions. It can also highlight potential areas of concern, like social health determinants. Understanding members’ conditions and barriers can help care teams guide members to effective preventive care, such as a primary care visit or diabetic eye exam.

Biometric tracking

DCM platforms may integrate with third-party biometrics trackers. Integrations allow members and care teams to track blood sugar, blood pressure, and physical activity. According to the JAMA study, “head imaging for syncope (fainting)” was the most common low-value service. If a member tracks their blood pressure, a care manager may be able to identify patterns and intervene to avoid adverse health outcomes.

Gaps in care

Additionally, DCM may improve overuse through identifying and confirming gaps in care. Some DCM platforms offer personalized content for healthcare education. Members can improve their own health literacy and become self-advocates. This helps members feel confident talking about their health with care providers. Some of those conversations could include asking for a second opinion or turning down low-value tests and procedures. DCM providers may help remove barriers to care and offer coordinated outreach to members.

Wellframe helps connect members to physicians that understand and listen to them. Educated members are more likely to stay involved in their care and be empowered to ask questions and seek out higher-value care options. Relationships like these help reduce the performance of unnecessary tests.

Want to learn more about how Wellframe’s Digital Care Management solution can help you improve member experience and care outcomes? Read our recent case study on maximizing care capacity and member engagement.