{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T05:07:06Z","timestamp":1764997626636,"version":"3.41.2"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T00:00:00Z","timestamp":1729641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Characterizing the value and equity of care delivered during the COVID-19 pandemic is crucial to uncovering health system vulnerabilities and informing postpandemic recovery. We used insurance claims to evaluate low-value (no clinical benefit, potentially harmful) and clinically indicated utilization of a subset of 11 ambulatory services within a cohort of \u223c2 million Virginia adults during the first 2 years of the pandemic (March 1, 2020\u2013December 31, 2021). In 2020, low-value and clinically indicated utilization decreased similarly, while in 2021, low-value and clinically indicated utilization were 7% higher and 4% lower, respectively, than prepandemic rates. Extrapolated to Virginia's population of insured adults, \u223c$1.3 billion in spending was associated with low-value utilization of the 11 services during the study period, with 2021 spending rates 6% higher than prepandemic rates. During March 1, 2020\u2013December 31, 2021, low-value and clinically indicated utilization were 15% and 16% lower, respectively, than pre-pandemic rates among patients with the greatest socioeconomic deprivation but similar to prepandemic rates among patients with the least socioeconomic deprivation. These results highlight widening healthcare disparities and underscore the need for policy-level efforts to address the complex drivers of low-value care and equitably redistribute expenditures to services that enhance health.<\/jats:p>","DOI":"10.1093\/haschl\/qxae133","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T13:14:54Z","timestamp":1729689294000},"source":"Crossref","is-referenced-by-count":2,"title":["Increased spending on low-value care during the COVID-19 pandemic in Virginia"],"prefix":"10.1093","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7910-6083","authenticated-orcid":false,"given":"Michelle S","family":"Rockwell","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine , Roanoke, VA 24016, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitaram","family":"Vangala","sequence":"additional","affiliation":[{"name":"The Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA , Los Angeles, CA 90024, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1283-3504","authenticated-orcid":false,"given":"Jillian","family":"Rider","sequence":"additional","affiliation":[{"name":"Virginia Health Information , Richmond, VA 23219, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-3904","authenticated-orcid":false,"given":"Beth","family":"Bortz","sequence":"additional","affiliation":[{"name":"Virginia Center for Health Innovation , Henrico, VA 23233, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0571-5975","authenticated-orcid":false,"given":"Kyle","family":"Russell","sequence":"additional","affiliation":[{"name":"Virginia Health Information , Richmond, VA 23219, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8564-1920","authenticated-orcid":false,"given":"Marcos","family":"Dachary","sequence":"additional","affiliation":[{"name":"Milliman MedInsight , Seattle, WA 98101, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4778-0190","authenticated-orcid":false,"given":"Lauryn","family":"Walker","sequence":"additional","affiliation":[{"name":"Virginia Center for Health Innovation , Henrico, VA 23233, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7734-6742","authenticated-orcid":false,"given":"A Mark","family":"Fendrick","sequence":"additional","affiliation":[{"name":"Center for Value-Based Insurance Design, University of Michigan School of Medicine and School of Public Health , Ann Arbor, MI 48109, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0322-7636","authenticated-orcid":false,"given":"John N","family":"Mafi","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA , Los Angeles, CA 90024, United States"},{"name":"RAND Health Care, RAND Corporation , Santa Monica, CA 90401, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"issue":"15","key":"2024121100020810400_qxae133-B1","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1001\/jama.2019.13978","article-title":"Waste in the US Health Care System: estimated costs and potential for savings","volume":"322","author":"Shrank","year":"2019","journal-title":"JAMA"},{"issue":"11","key":"2024121100020810400_qxae133-B2","doi-asserted-by":"publisher","first-page":"e2342445","DOI":"10.1001\/jamanetworkopen.2023.42445","article-title":"We need to talk about low-value care","volume":"6","author":"Moriates","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"9","key":"2024121100020810400_qxae133-B3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.37765\/ajmc.2020.88412","article-title":"Crisis into opportunity: can COVID-19 help set a path to improved health care efficiency?","volume":"26","author":"Kim","year":"2020","journal-title":"Am J Manag Care"},{"key":"2024121100020810400_qxae133-B4","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20201023.522078","article-title":"The COVID-19 pandemic can help us understand low-value health care","author":"Oakes","year":"2020","journal-title":"Health Affairs Forefront"},{"issue":"11","key":"2024121100020810400_qxae133-B5","doi-asserted-by":"publisher","first-page":"600","DOI":"10.37765\/ajmc.2022.89031","article-title":"Changes in use of low-value services during the COVID-19 pandemic","volume":"28","author":"Shazad","year":"2022","journal-title":"Am J Manag Care"},{"issue":"15","key":"2024121100020810400_qxae133-B6","doi-asserted-by":"publisher","first-page":"3979","DOI":"10.1007\/s11606-022-07757-1","article-title":"The association of the first surge of the COVID-19 pandemic with the high- and low-value outpatient care delivered to adults in the USA","volume":"37","author":"Levine","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"4","key":"2024121100020810400_qxae133-B7","doi-asserted-by":"publisher","first-page":"e218075","DOI":"10.1001\/jamanetworkopen.2021.17001","article-title":"Assessment of overuse of medical tests and treatments at US hospitals using medicare claims","volume":"4","author":"Chalmers","year":"2021","journal-title":"JAMA Network Open"},{"issue":"26","key":"2024121100020810400_qxae133-B8","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible\u2014the neighborhood atlas","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"key":"2024121100020810400_qxae133-B9"},{"issue":"10","key":"2024121100020810400_qxae133-B10","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1377\/hlthaff.2017.0385","article-title":"Low-cost, high-volume health services contribute the most to unnecessary health spending","volume":"36","author":"Mafi","year":"2017","journal-title":"Health Aff Proj Hope"},{"issue":"2","key":"2024121100020810400_qxae133-B11","doi-asserted-by":"publisher","first-page":"e2037328","DOI":"10.1001\/jamanetworkopen.2020.37328","article-title":"Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018","volume":"4","author":"Mafi","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"11","key":"2024121100020810400_qxae133-B12","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1001\/jamainternmed.2021.5531","article-title":"Low-value care at the actionable level of individual health systems","volume":"181","author":"Ganguli","year":"2021","journal-title":"JAMA Intern Med"},{"issue":"7","key":"2024121100020810400_qxae133-B13","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1158\/1940-6207.CAPR-22-0531","article-title":"Reallocating cervical cancer preventive service spending from low- to high-value clinical scenarios","volume":"16","author":"Rockwell","year":"2023","journal-title":"Cancer Prev Res (Phila)"},{"issue":"6","key":"2024121100020810400_qxae133-B14","doi-asserted-by":"publisher","first-page":"e208","DOI":"10.37765\/ajmc.2021.88642","article-title":"A 10-step program to successfully reduce low-value care","volume":"27","author":"Beckman","year":"2021","journal-title":"Am J Manag Care"},{"issue":"Suppl2","key":"2024121100020810400_qxae133-B15","doi-asserted-by":"publisher","first-page":"w195","DOI":"10.1377\/hlthaff.26.2.w195","article-title":"Value-based insurance design","volume":"26","author":"Chernew","year":"2007","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"2024121100020810400_qxae133-B16","doi-asserted-by":"publisher","first-page":"e2356121","DOI":"10.1001\/jamanetworkopen.2023.56121","article-title":"Area-level socioeconomic disadvantage and health care spending","volume":"7","author":"Morenz","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"12","key":"2024121100020810400_qxae133-B17","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1377\/hlthaff.2022.00482","article-title":"Use of area-based socioeconomic deprivation indices: a scoping review and qualitative analysis","volume":"41","author":"Trinidad","year":"2022","journal-title":"Health Aff (Millwood)"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxae133\/59984670\/qxae133.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/2\/11\/qxae133\/61005440\/qxae133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/2\/11\/qxae133\/61005440\/qxae133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:40:57Z","timestamp":1733877657000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxae133\/7831812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,23]]},"references-count":17,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,10,29]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxae133","relation":{},"ISSN":["2976-5390"],"issn-type":[{"type":"electronic","value":"2976-5390"}],"subject":[],"published-other":{"date-parts":[[2024,11]]},"published":{"date-parts":[[2024,10,23]]},"article-number":"qxae133"}}