On SAGE Insight: Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review

From Medical Care Research and Review

This article systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. As U.S. health care costs continue to outpace inflation, the need for solutions to improve the efficiency of care delivery is high. Many programs to reduce health care costs use reductions in reimbursement, benefit structures, and eligibility. However, reducing wasteful care could provide an important avenue for health care cost reduction without curtailing clinically beneficial services or reducing benefits coverage. Health care delivery models and payment strategies are evolving in response to strong forces that include unsustainable spending, emerging technology, and growing patient participation. These forces are aligning to promote a better understanding of care value, which should facilitate improved use of health services. While the literature reveals important evidence on strategies used to reduce low-value care, meaningful gaps persist. More experimentation, paired with rigorous evaluation and publication, is needed.

Abstract

The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. This article systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. We found that multicomponent interventions addressing both patient and clinician roles in overuse have the greatest potential to reduce low-value care. Clinical decision support and performance feedback are promising strategies with a solid evidence base, and provider education yields changes by itself and when paired with other strategies. Further research is needed on the effectiveness of pay-for-performance, insurer restrictions, and risk-sharing contracts to reduce use of low-value care. While the literature reveals important evidence on strategies used to reduce low-value care, meaningful gaps persist. More experimentation, paired with rigorous evaluation and publication, is needed.

 

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Article details2
Carrie H. Colla, Alexander J. Mainor, Courtney Hargreaves, Thomas Sequist, and Nancy Morden
Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review
Med Care Res Rev 1077558716656970, first published on July 8, 2016 doi:10.1177/1077558716656970

 

 

     
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