Low-value health care—services of low, no, or even negative impact on patients, as well as services delivered in an unsafe or inefficient manner—is pervasive across the globe. Some widely used services are clinically inappropriate for most patients under most circumstances. Examples include doing an EEG for an uncomplicated headache or a CT or MRI for lower back pain in patients without signs of a neurological problem.1 More examples of low-value care are the misuse of some medications, including opioids and antibiotics, which have led to growing problems in opioid abuse and antibiotic-resistant bacteria.
Reducing low-value care has proved to be a hard and slow task.2 Nevertheless, doing so is likely essential if we are to lower costs while also pursuing innovation and improving health quality and outcomes. In the United States alone, the financial toll of low-value care is estimated in hundreds of billions of dollars (see sidebar “The high price of low-value care”). In addition, low-value care arising from medical errors and operational inefficiencies in service delivery can result in adverse patient outcomes, excessive costs (including fraud), and poor patient experience. Reducing and ultimately eliminating low-value services are likely essential to achieving value-based care, in which a treatment's effectiveness ultimately helps to determine its value.
The Deloitte Center for Health Solutions conducted extensive research and interviewed experts to see what is working globally to reduce low-value care. The resulting case studies, spanning 10 organizations in five different countries, illuminate four avenues for reducing low-value care:
- Providing the right care: Curbing services that offer few or no patient benefits
- Delivering care in the right setting: Curtailing unwarranted emergency department utilization
- Delivering care safely: Tackling safety failures
- Providing care in the right way: Rooting out operational inefficiencies
In these 10 case studies, and throughout the paper, we highlight where effective use of technology has made a difference, from seemingly simple fixes such as including patient photographs in electronic health records to improving clinician training with Wi-Fi-enabled robots that simulate patients. We also show where emerging applications could make even more of an impact in the future in terms of improving outcomes or reducing costs. In other cases, we show how seemingly simple ideas or process redesigns, such as regular review of elderly patients' drug regimens by pharmacists or incorporating lean principles throughout a hospital, can significantly reduce costs or improve outcomes when implemented effectively. Taken together, these examples show how health care organizations can reduce low-value care in favor of the right care, in the right setting, safely, and in the right way.
Read more about the topic and explore how some organizations globally are using innovative approaches and technologies to combat this issue.
Footnotes
- Atul Gawande, “Overkill,” New Yorker, May 11, 2015. View in article
- Carrie H. Colla and Alexander J. Mainor, “Choosing Wisely campaign: Valuable for providers who knew about it, but awareness remained constant, 2014–2017,” Health Affairs 36, no. 11 (2017), DOI:10.1377/hlthaff.2017.0945. View in article
