Reducing Low-Value Care and Improving Health Care Value

Low-value care, defined as the use of a health service for which the harms or costs outweigh the benefits, is a pervasive and enduring problem in the US. Enacting policies that limit reimbursement for low-value services is an important step in mitigating such care. For example, Powers et al¹ proposed a framework to identify and prioritize policies to govern the de-adoption of low-value care focused on evidence, eminence, and economics. However, transitioning to a state of health care delivery that prioritizes value over volume will require balancing “top-down” policy prescriptions with a “bottom-up” approach geared toward affecting local cultural change. Such an approach involves implementing de-adoption strategies tailored to address the behavioral and organizational factors that drive the provision of low-value care within a local health care ecosystem, whether it is an individual practice or a tertiary referral center.