The use of low-value care is more than just a small problem in the United States, the Institute of Medicine indicated an estimate of $765 billion wasted health care expenditures in 2013 (Figure 1). Solutions to measure, identify, and eliminate low-value care, however, 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.
In order to get a better understanding of the complexities of low-value care, we conducted interviews with 13 people representing a breadth of perspectives including clinicians from professional medical societies, payers, employer benefit design professionals from large organizations, and expert health economists. The interviews were funded by the National Pharmaceutical Council and conducted by the Altarum Institute. We 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.
Based upon these interviews, there was a profound lack of consensus on how to incorporate clinical nuance, patient preferences and priorities, and cost-benefit tradeoffs into provider and consumer-facing initiatives to reduce low-value care.