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Comment & Response
March 2, 2021

The De-adoption of Low-Value Health Care—Reply

Author Affiliations
  • 1Humana Inc, Louisville, Kentucky
  • 2SCAN Group and Health Plan, Long Beach, California
JAMA. 2021;325(9):888. doi:10.1001/jama.2020.25518

In Reply We agree with Dr Donzelli that reforming health care payment is an essential step in reducing the delivery of low-value services. This is core to our argument around the economic forces that guide the de-adoption of low-value care.1 Within this realm of economic levers, Donzelli makes an important distinction between pay-for-performance and pay-for-health models, noting some inconsistent results from the former. Although there is evidence that targeted payment policies can reduce the provision of low-value care,2 we agree that more holistic value-based payment models are needed. Our understanding of how to best pay for health continues to evolve and requires precise measurement of and alignment around the definition of health. One approach raised by Donzelli is to move toward risk-adjusted capitated payments, an approach already used at scale within the Medicare Advantage program. There is also some evidence to suggest that other global payment structures influence the provision of low-value services.3 As the adoption of value-based payment continues to grow, it will be important to rigorously evaluate the impact on low-value care.