Reducing the use of low-value care
is one of the few opportunities to increase quality while, at the same time, decreasing spending on care.
Reducing the use of low-value care—care for which the potential for harm exceeds the possible benefit—is an attractive but elusive goal in health care. It is one of the few opportunities to increase quality while, at the same time, decreasing spending on care. Traditionally, there has been little consensus on what constitutes low-value care and little opportunity to measure it and design interventions to target it. That has changed in recent years due to physician-led efforts to build consensus around what tests and procedures qualify as low-value (e.g., the Choosing Wisely campaign), as well as a number of preliminary analyses aimed at quantifying use of low-value care.
Many services identified as low-value are routine imaging and laboratory tests. These services can be relatively low-cost and low-risk, but they may initiate a cascade of subsequent services with much greater impact on both patient outcomes and health care spending.
Little is known about: the prevalence and variation in episodes of low-value care; the effect of payment reform interventions on use of low-value care and related episodes; and which characteristics best position a provider organization to reduce use of low-value care. Addressing these knowledge gaps and reducing low-value care will decrease harm to patients, reduce unnecessary spending, and improve the quality of health care delivery.
Our research team will construct episodes of low-value care that include tests, procedures, and treatments related to an initial low-value test. We will then examine the prevalence and cost of each type of episode among Medicare beneficiaries. This analysis builds upon previously developed measures of low-value care, and relies on use of a full sample of national Medicare data. We will then study the effect of Medicare accountable care organizations (ACOs), including specific ACO features, on utilization of low-value care in the United States among Medicare beneficiaries. Finally, we will use the National Survey of ACOs (NSACO) to understand which ACO characteristics are most closely associated with successful reduction in low-value care.