The problem of overuse, unnecessary care, or low-value care is increasingly a focus of the national health policy conversation. Estimates suggest that as much as one-third of health care spending in the United States is of low-value or wasteful. Many factors contribute to the problem, including increased patient demand, information asymmetry, perverse financial incentives for providers, and a culture of “more is better than less.”
In order to advance research development and to inform efforts to reduce overuse in the United States and globally, AcademyHealth and the ABIM Foundation have been partnering since 2014. Initially assessing the landscape of research being conducted on low-value care, we then focused on priorities for studies of interventions to reduce low-value care, which were then disseminated to multiple research funders. From these initial efforts, the partnership evolved with the development of a research community on low-value care composed of diverse stakeholders to coordinate efforts in low-value care research and an initiative to develop priorities for patient-centered low-value care measures. In 2018, the Donaghue Foundation joined AcademyHealth and the ABIM Foundation in supporting the research community on low-value care.
Pilots & Programs
Research Community on Low-Value Care
AcademyHealth and the ABIM Foundation launched the Research Community on Low-Value Care in April 2016, and the Donaghue Foundation joined this partnership in October 2018. The community was a professional network for research producers and users to advance their work in eliminating low-value care in the U.S. and abroad. Composed of over 400 members, the community included researchers in academic and other settings, health system representatives, patients/consumers, clinicians, health plans, and policymakers. The goals of the research community included:
- Fostering connections, communications, and collaborations among researchers and end-users with an interest in reducing low-value care;
- Facilitating exchange of information on new evidence, research methods, and funding opportunities;
- Identifying and spurring dialogue on shared challenges and key priorities for strengthening research, practice, and policy; and
- Helping to generate new collaborations to conduct research or implement research findings.
Joining the community provided members with the opportunity to connect and interact with peers; augment their knowledge on the latest research evidence, best practices, tools, data, and funding opportunities; and access webinars, sessions, and thematic groups to learn, network, and find opportunities for collaboration to address key low-value care challenges.
This research community is no longer active. If you are interested in joining our new research community on High-Value, Equitable Care, or would like to learn more, please fill out this brief form or email firstname.lastname@example.org.
One of the major barriers to reducing low-value care is our ability to identify instances of such care. In response to this significant need, and with support from the Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award, AcademyHealth and the ABIM Foundation spearheaded deliberative dialogues and priority setting with multiple stakeholder groups to assess the state of measures and future research needs to develop, test, and implement measures that will help identify low-value care while taking into account patient perspectives.
The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review
New research published in The Milbank Quarterly shows how the ABIM Foundation’s Choosing Wisely campaign has been used by health systems to successfully reduce the use of low-value medical services. The ABIM Foundation launched the initiative in 2012 to advance a national dialogue on reducing low-value medical practices, including unnecessary medical tests, treatments and procedures. The study examined 131 published articles on Choosing Wisely’s impact between 2012 and June 2019, and found that active, multi-component interventions were more likely to generate reductions in overuse than merely disseminating Choosing Wisely recommendations. Published August, 2021.
A Project Delving Into Low-Value Care Among Black And Latinx Communities During 2020: What Its Two Funders Learned
In this HealthAffairs Grantwatch blog, former Donaghue Foundation Vice President Nancy Yedlin and ABIM Foundation Program Officer Kelly Rand reflect on their experiences funding the work of AcademyHealth’s Thematic Working Group on Low-Value Care among African American and Latinx Populations. They discuss the considerations needed when supporting intersectional, multistakeholder work and the dynamics of collaborating with other funders on awarding grants and managing the grantee relationship. This blog provides insight into successfully establishing and maintaining multistakeholder research groups that are critical for addressing complex issues. Published July, 2021.
Time To Set Aside The Term ‘Low-Value Care’—Focus On Achieving High-Value Care For All
In a blog post in Health Affairs, members of AcademyHealth’s Thematic Working Group on Low-Value Care among African American and Latinx Populations call for a reexamination of the terms low-value care and high-value care, and what they mean to the wellbeing of communities of color. The blog post makes the case for reimagining the terminology of “low-value care” to consider African American, Latinx, and other racial and ethnic communities. Published May, 2021.
Digital Health & Low-Value Care
In a new Healthcare commentary, members of an AcademyHealth thematic working group consider whether the potential harms of digital health outweigh the benefits. Authors explore three types of low-value digital health care—ineffective care, inefficient care, and unwanted care—and propose policy solutions. Published March, 2021.
Imagining a World Without Low-Value Services: Progress, Barriers, and the Path Forward
Reflecting upon the 2019 Summit, “Imagining a World Without Low-Value Care: What Will it Take?” sponsored by AcademyHealth, the Donaghue Foundation, and the ABIM Foundation, in collaboration with the Kaiser Permanente Center for Total Health and the Veterans Administration, this commentary published in the American Journal of Managed Care explores the main barriers preventing progress against low-value care and highlights promising solutions. Published March, 2021.
Prioritizing High-Value, Equitable Care After the COVID-19 Shutdown: An Opportunity for a Healthcare Renaissance
AcademyHealth CEO Lisa Simpson and colleagues from the low-value care research community reflect on the opportunities and challenges facing healthcare systems as they reboot from COVID-19 shutdowns. Framing this moment as an opportunity to focus on providing patients with high-value, equitable care, authors share lessons learned from medical centers that have begun reopening: keep patients central, deliberately avoid low-value care, proactively address healthcare disparities, and reform to support high-value care delivery. Published February, 2021.
What Is The Status Of Research On Low-Value Care?
This post on the Health Affairs Grantwatch Blog analyzes trends in Low-Value care research over the past five years, as documented in the database HSRProj. The analysis examines the overall volume of research conducted, the leading funders and the research phase of projects conducted, among several other attributes. Published January 8, 2020.
Reducing Low-Value Care Among Vulnerable Populations
This post on the Health Affairs blog emphasizes the need to reduce low-value care among vulnerable population, and discusses challenges and opportunities in doing so. This blog post was a product of a Thematic Working Group focused on Low-Value Care Among Vulnerable Populations, commissioned by the Research Community on Low-Value Care. Published June 10, 2019.
Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review
The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. In this paper, Dr. Carrie Colla and authors systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. Published July, 2017.