What is low-value care?
Low-value care refers to treatments or services that offer little to no benefit for patients and, in some cases, may even cause harm.
Why is low-value care a problem?
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, how can the U.S. health care system 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 the use of treatments and services that are inefficient, increase costs and have little or no benefit for patients. Known as “low-value care,” these services and treatments cost the U.S. health care system more than $340 billion in wasted spending each year.
Why is action on low-value care needed?
Eliminating low-value care can help enhance the patient experience, improve quality and lower costs. Savings could be used to help fund other health care priorities, such as:
- Expanding access to insurance for millions of uninsured Americans,
- Offering enhanced coverage for high-value clinical care,
- Providing funding for social determinants of health, and
- Establishing the means to provide long-term care services and support that the growing senior population will soon require.
How can administrators and clinicians reduce low-value care?
One way to ensure resources are used for interventions that provide the most value for patients is to identify and eliminate treatments and services that are inefficient, increase costs and have little or no benefit for patients.
Various efforts, including the Choosing Wisely initiative, have focused on the areas where there is general agreement, like the use of vitamin D screening tests and MRIs for low-back pain. Identifying wasteful or unnecessary medical tests, treatments and procedures has allowed physicians to make better decisions about a patient’s care plan based on their unique situation and helped reduce the cost of care.
To keep these efforts moving forward, it’s important to understand where further consensus exists on defining and measuring other areas of low-value care. A 2016 NPC study based on interviews with experts identified three areas of agreement for further efforts to reduce low-value care, improve quality and lower costs. They include:
- Reducing medical errors, which is the highest priority,
- Resolving pricing failures, and
- Avoiding overuse and overtreatment.
Building on previous efforts aimed at reducing low-value care, the Going Below The Surface Forum – an expert group of stakeholders from key segments of health care, including payers, provider groups, patient advocacy groups and academic researchers – developed a roadmap to guide health care stakeholders as they consider and implement interventions that address low-value care. The roadmap is designed to serve as a reference guide to help organizations think about the questions, considerations and potential goals they need to achieve to implement an intervention or program aimed at addressing low-value care.
What are the barriers to eliminating low-value care?
Unfortunately, low-value care has been a stubbornly persistent problem in the U.S. health system for several decades, and historical efforts to curb it have achieved limited success. A 2020 NPC study examined why low-value care continues to be so pervasive and identified several barriers to the de-implementation of low-value care. Barriers exist across all levels of health care, from macro-level societal hurdles to micro-level barriers facing patients and consumers. Therefore, successfully addressing low-value care will require a comprehensive approach that considers the various obstacles present throughout U.S. health care.
How can future efforts aimed at reducing low-value care be improved?
When designing interventions to reduce low-value care, it’s important to understand which services or areas of care to target to achieve the greatest reduction in low-value spending. NPC conducted a literature review of the existing research on low-value care spending and found further evidence of substantial spending on low-value care in the U.S. health system. More work is needed to improve efforts to identify and measure a broad range of low-value services. Regardless of limitations in the current evidence base, NPC’s analysis found clear examples of low-value care that, if addressed, could contribute to substantial cost saving and improvements in patient care.
At a much higher policy level, several specific steps could be taken to guide future low-value care efforts, including:
- recognizing existing barriers across the health system to identify areas for intervention,
- determining levels of care and stakeholders to target,
- designing evidence-based, multi-component interventions, and
- addressing evidence gaps.