Taking a Look at What Causes Low-Value Care

By | June 3, 2021

Low-value care is defined as the utilization of health services that harm or in which the costs outweigh the possible benefits and there are many reasons for these actions. The desire for clinicians to eliminate situations that might cause harm is a driving factor. Although they may be unable to inform you of precisely what is occurring in your body, the provider can deduce what is not happening through the aggressiveness of their search. Unfortunately, this line of reasoning may lead to diagnostics that could be of low-yield, cause further harm and an increase of costs to the system and the consumer.

Additionally, our present fee-for-service payment model is attributed to low-value care, where the cost or harm is not connected to the payment for a service or procedure. Currently, there is no financial disincentive to doing “more” to ensure nothing is wrong.  However, there is also an overuse in non-fee-for-service models; thus, the financial payment model appears to have little impact. Consequently, this leads us to delve into other reasons.

Let’s take a look at some of these reasons…

For starters, frequently, clinician behaviors are driven not only by personal decisions but also by cultural and organizational drivers. Therefore, addressing these reasoning drivers becomes paramount to altering the underlying behaviors. The first step to any behavioral change, regardless of the individual, cultural, or organizational component, is the measurement of low-value care and comparing those results to evidence-based recommendations. The practice of comparisons to benchmarks allows us to “see” where there is variation. Of course, with medicine being an imperfect science and since we do not have evidence on everything, there will be appropriate variation to allow for the “art” element of healthcare delivery.

Second, roadmaps for de-adoption efforts must occur. These measurement results are quality factors that can become a standard component of discussion and intervention. Furthermore, quality improvement initiatives are steeped in success, thus addressing low-value care as a quality metric allows us to utilize our performance improvement infrastructures to address this area of concern. Preventive care and population health initiatives have focused on the underutilization of needed services. The same idea and focus needs can occur on the over usage of low-value care.

Third, when the provider orders health services, interventions designed to intervene must align with the motivations of both patients and clinicians. The provider must discuss, with purposeful attention, the tangible harms associated with the intervention and the potential for low-yield at the beginning of the diagnostic process. These conversations are part of shared decision-making.

Fourth, we must address the cognitive biases and attitudes that exist. No one is providing low-value care purposefully. Undoubtedly, everyone has their reasons. By creating the environment for open communication within the profession concerning this topic, we have the potential to identify and mitigate underlying reasoning. No one wants to do harm. We must alter our conversation to one on improving care rather than one of criticizing a clinician who is seeking further answers.

Lastly, there are systematic approaches that will aid in improving our ability to change. Making the “more appropriate” choices easier to do, and making the “less appropriate” decisions harder, requires us to address our technology systems to support habit changes. To address low-value care, we must apply a behavioral and systematic approach that comprises all the variables associated with our current decision-making processes.