PHP69 - Challenges to Reducing Low-Value Care: Lessons Learned and Future Directions

Abstract

Healthcare systems are increasingly recognizing that to control costs it is necessary to reduce the use of unnecessary, ineffective, inefficient, or harmful care. Consequently, efforts have been introduced in recent years to address low-value care. Despite these initiatives, evidence of their success has generally been limited or mixed. This research aimed to identify key barriers influencing their implementation and impact; ascertain potential incentives, strategies, and/or policies to address identified challenges; and, explore the overall feasibility of these low-value care initiatives to meet their identified aims. The research employed a two-stage approach. First, a literature review of peer-reviewed and grey literature (n=289 articles) was conducted to ascertain key challenges or barriers of low-value care initiatives and identify potential strategies for improvement. Second, semi-structured senior expert interviews (n=15) were conducted to further explore the key themes identified in the literature review. The experts interviewed were selected based on their vast and varied experience across related issues, including health care spending, resource allocation, coverage and payment policy, value assessment and evidence-based medicine, among others. Key challenges identified include over-focus on low-use or low-impact interventions; difficulty identifying, measuring, or monitoring low-value care; lack of policymaker, physician, and patient knowledge, buy-in, and/or political will; limited consensus on what constitutes “value” and “low value care” among different stakeholders; legal/malpractice concerns; cultural attitudes and expectations regarding treatment access and choice; current payment systems that incentivize volume over value; and, limited systemic levers to support low-value care initiatives. Strategies for improvement emphasized multi-component interventions, better use of information systems (e.g., EHRs) and evidence of effectiveness (e.g., CER), provider education tied to incentives, strengthened low-value measures, and more significant value-based payment reforms. While improvements can be made to current initiatives, more significant systemic changes are likely needed to effectively reduce low-value care and attain greater value in health care.