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Trying to define and reduce low-value care

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A  new Health Affairs article is based on discussions with 13 experts on how to reduce  low-value care.  Little consensus was found.

The authors noted: “Solutions to measure, identify, and eliminate low-value care … are challenging and complex. To date, most efforts aimed at reducing low-value care, such as the Choosing Wisely Initiative, have been limited to areas where there is high degree of consensus that the care rendered is low value.”

The authors said they focused on “overuse/overtreatment, failures of care delivery and coordination, and pricing failures. We proposed working definitions of low-value care and explored how participants considered defining and measuring low-value care.”

Findings include:

  • “There is a healthy skepticism of consensus methods, such as Choosing Wisely, in identifying low-value care beyond obvious ‘low-hanging fruit.’ There was not clear consensus on how to use components such as patient preferences, health-related quality of life, or competing risks and risk-benefit tradeoffs (e.g., at what age to initiate and terminate certain preventive screenings) to define and measure low-value care.
  • “There was little consensus on the validity, practical application, and priority for using cost-effectiveness analysis to inform coverage and pricing decisions.”
  • “Although there was agreement that price and cost should be included, particularly unjustified price variation, (e.g., price at freestanding versus facility-adjoined surgical or infusion therapy center) in efforts to reduce low-value care, there was not clear agreement on how that should be done.”

Still, the interviewees agreed  on elements of low-value care that need immediate attention. Among them: medical errors and pricing failures.

The writers proposed the following actions:

  • Looking into incorporating “Choosing Wisely, USPTF, and similar lists into performance and quality measurement for alternative payment programs.”
  • Expanding current low-value care lists “beyond nearly universal low-value care to include items where value is circumstance-dependent. Given concerns about limiting access to appropriate care, we recommend a tiered approach that takes into account both the magnitude and certainty of low-value care use. This effort would need to incorporate patient protections.”

T0 read the article, please hit this link.

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