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Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure.
The triple aims of value-based care—improving member experience, population health, and cost per capita in healthcare—all draw on utilization measurement data.
When utilization of unnecessary services is low, member experience may improve. Also, by tracking how often certain populations use healthcare services and which services are most utilized, healthcare leaders and policymakers can gain insight into healthcare trends across a community.
And, of course, utilization is closely tied to healthcare spending. This was evident in 2020 when the annual percent change in utilization per person dropped 7.5 percent, and spending per person followed, declining from 4.1 percent growth in 2019 to a 3.6 percent decrease in spending per person in 2020. However, the connection between utilization and spending is not always aligned.
The goal of value-based care is not to drastically reduce healthcare utilization to control healthcare spending. Instead, payers aim to identify and reduce utilization of low-value services while incentivizing the utilization of high-quality care.