Event Date:
Event Date Details:
Wednesday May 21, 2025
Event Location:
- HSSB 1174
Event Price:
FREE
Event Contact:
Dr. Steve Schramm
- Department Seminar
Abstract
Low value care, services that are inconsistent with evidenced-based medicine, expose patients to needless risk, and can cause adverse outcomes, remains a pervasive and costly issue in the U.S. healthcare system. This study analyzes administrative claims and eligibility data from three state Medicaid programs to evaluate ten low value care measures across categories of aid (COA), age, gender, ethnicity, and income proxies. Significant variation in both utilization and expenditure was found across states and subpopulations. We demonstrate that results are sensitive to how low value care is defined and calculated, underscoring the need for standardized methodologies. To address this, we propose a consistent measurement template to support comparability across states.
We also demonstrate relationships between low value care and patient characteristics. Focusing on the five highest-cost measures—such as early opioid prescribing for back pain and inappropriate imaging for uncomplicated conditions—we apply four regression approaches: (1) OLS with a log-transformed outcome, (2) a Tweedie GLM, (3) a two-part compound Poisson-Gamma model, and (4) a frequency-severity model combining binomial and gamma components. While some demographic characteristics showed weak associations with low-value care utilization, the models explained only a small share of variation, and the statistics suggest the models are mis-specified and are missing potentially important explanatory variables.
Our findings suggest that actuarial adjustment for demographic and programmatic differences is essential, and that more granular, state-specific research is needed to effectively inform Medicaid policy.
Keywords: Medicaid, low value care, health expenditures, value-based purchasing, regression modeling, measurement variation
Bio
Steve Schramm, PhD
Steve Schramm is a health economist with over four decades of experience in U.S. healthcare policy and reform. He earned his BA in Economics from Arizona State University, an MSc in Health Economics from the London School of Economics, and a PhD in Actuarial Sciences from the Cass Business School at City, University of London.
Dr. Schramm has advised both public and private sector clients across more than three dozen states, focusing on Medicaid transformation, payment reform, and strategies to improve health equity and access. His work has been featured by several non-partisan health policy organizations, and he is a frequent speaker on the future of healthcare delivery and financing in the U.S.
His current focus is on helping payers and policymakers navigate uncertainty and build systems that ensure timely, cost-effective access to services—particularly for underserved populations.