Top Things to Know: Strategies to Reduce Low-Value Cardiovascular Care
Published: February 22, 2022
- Low-value care can be defined as health care services that provide no “net benefit”, considering the potential of the service to provide meaningful health benefits, the potential to cause harm, any existing alternatives, and the cost to patients and society.
- Low-value care is common and costly, accounting up to 30% of healthcare spending or up to $101 billion annually. Cardiovascular care may be particularly prone to being considered low-value given the high prevalence of disease, and the rapid pace of innovation in tests and therapeutics.
- Low-value care diverts resources from services that would otherwise benefit patients more effectively and can result in direct physical and financial harm to patients. Thus, reducing low-value care is a patient-centered approach to improving the quality and efficiency of healthcare.
- Patient education and shared decision-making are effective patient-centered approaches to reducing low-value care. Such approaches may be most useful when misconceptions exist about the intended purpose of a test or treatment.
- Clinician-level approaches to reduce low-value care may be most effective when they are “layered”, such as through a combination of educational efforts, audit and feedback, and behavioral science tools (“nudges”) to encourage high-value clinical decision making.
- Many new payment and healthcare delivery models have recently been implemented. Accountable care organizations have demonstrated modest reductions in low-value care, but less is known about other models, such as pay-for-performance and episode-based payments.
- Prior authorization may be effective in reducing some low-value health care services but has many drawbacks such as creating a high administrative burden on health care professionalsand potentially denying access to care among patients who may benefit from the service.
- Interventions to reduce low-value care may unintentionally worsen existing disparities in care based on race/ethnicity, sex/gender, age, and socioeconomic status. Policies and interventions to reduce low-value care must be designed with at-risk populations in mind, and rigorously studied after implementation.
- Applying a single solution to reduce low-value care is unlikely to be successful. It is important to consider and act across different perspectives and use multiple synergistic approaches to increase the likelihood of success.
- High-impact research priorities include developing novel strategies for patient engagement, incorporating patient-reported outcomes into value assessments, strategies to broadly implement and sustain evidence-based interventions, conducting longitudinal value assessments of tests and therapeutics of uncertain value, and testing the impact of new payment and delivery models on low-value care.
Citation
Kini V, Breathett K, Groeneveld PW, Ho PM, Nallamothu BK, Peterson PN, Rush P, Wang TY, Zeitler EP, Borden WB; on behalf of the American Heart Association Council on Quality of Care and Outcomes Research. Strategies to reduce low-value cardiovascular care: a scientific statement from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2022;15:e000105. doi: 10.1161/HCQ.0000000000000105