Walking the Walk: Taking Needed Steps to Reduce Low-Value Care

By Robert Dubois, MD, PhD
NPC Chief Science Officer and Executive Vice President

Growth in U.S. health care spending has led to intensifying concern among health care decision-makers, policymakers and patients about the cost and value of health care. Given this rising concern, it’s vital for the U.S. health care system to focus its resources and spending on interventions that provide the most value for patients.

To improve how health care resources are optimized, a good first step is to identify and reduce “low-value care” -- the use of treatments and services that are inefficient, increase costs and have little or no benefit for patients. These services and treatments have contributed significantly to overall health care spending, costing the U.S. health care system more than $340 billion in wasted spending each year.

Low-value care is a stubbornly persistent problem that has vexed the health care system for several decades. Ongoing efforts to rein in low-value care via innovative payment models (e.g., accountable care organizations and bundled payments), educational initiatives (Choosing Wisely), and interventions targeted to individual providers and individual services, have achieved limited success. That’s because these efforts have come up against barriers across all levels of health care, from macro-level societal hurdles to micro-level barriers facing patients and consumers.

Successfully addressing low-value care will require a holistic approach that considers the various obstacles present throughout the U.S. health care system and engages leaders throughout health care organizations. That’s why it was especially encouraging to see three leading researchers detail “A 10-Step Program to Successfully Reduce Low-value Care” in the latest edition of The American Journal of Managed Care. In particular, they outline steps to reduce low-value care using a “respectful, data-driven process anchored in non-judgmental communication and explicit core values.”

Their 10 steps are focused on the need to set goals, obtain buy-in and collaborate across an organization, and track progress. Their approach complements a similar effort developed last year by the Going Below The Surface (GBTS) Forum, a group comprising experts across the health care sector, including employers, health plans, provider groups and patient advocacy organizations. GBTS developed a guide, the Roadmap for Addressing Low-value Care, that serves as a reference tool to help organizations consider key goals, questions and tactics to effectively develop and implement a plan to focus on services that incentivize optimal outcomes. Designed for a broad constituency of health care stakeholders, the turn-by-turn Roadmap provides stakeholder-specific examples of potential interventions to reduce low-value care in a tangible and implementable way.

Low-value care may be a pervasive problem, but it is not insurmountable. Working inside and across organizations, stakeholders can commit to collaboratively identifying better ways to incentivize and deliver high-value care, avoid harm and use scarce resources wisely. By coming together and taking a multi-pronged approach, stakeholders can make significant strides toward overcoming low-value care.