The economic impact imposed by the coronavirus pandemic has caused unprecedented financial disruption to a system already grappling with questions around how to allocate limited resources. The financial strain imposed on public and private insurers, hospital systems and patients underscores the need to discuss strategies that support the delivery of high-value care.

Even before the pandemic, low-value care – treatments or services that don’t offer real value to patients, and in some cases may even cause harm – had been contributing significantly to overall health care spending. In the United States, as much as $340 billion is spent on low-value or unnecessary care alone. Post pandemic, there is every reason to believe that low-value care will still be there.

To improve how we use our resources in a way that maximizes high-value services and minimizes low-value ones, the Going Below The Surface (GBTS) Forum – a group of experts across the health care sector, including payers, provider groups and patient advocacy organizations – developed a guide, Roadmap for Addressing Low-value Care.  The Roadmap is designed to serve as a reference tool to help organizations consider key goals, questions and tactics to effectively implement a plan to focus on services that enable optimal outcomes. Catering to a broad constituency of health care stakeholders, the guide provides stakeholder-specific examples for potential interventions to reduce low-value care.

The step-by-step guide was outlined by a group of experts and academics convened by the GBTS Forum to identify key considerations for ensuring the effective use of health care resources. Using their real-world experience and academic expertise, this task force compiled a menu of considerations, as well as illustrative examples stemming from peer-reviewed and gray literature sources. The Roadmap focuses efforts on prioritizing high-value care, such as life-saving vaccines, and eliminating wasteful spending, giving funds back to the system to ensure the health care system is more effective and capable during this unprecedented time.

“Patients deserve evidence-based care. Unfortunately, too many instead receive suboptimal, unnecessary, duplicative and even dangerous tests, procedures and medications – costing everyone millions. Our nonprofit health plans work closely with clinical teams to eliminate this low-value care and the Roadmap will be a valuable tool in that effort,” said Ceci Connolly, President and CEO, Alliance of Community Health Plans.

“Medical groups and health systems are working to create health care that is more accessible, affordable and sustainable. By moving to value-based payment models, where the financial incentives reward high quality and cost efficiency, these high-performing providers are transforming how health care is organized and delivered.  One area of focus has been low-value care, treatments or services that don’t offer real value for patients. In the value-based world, low-value care is an obvious target that should rally providers, patients and payers. The Roadmap provides a systematic approach to reducing or eliminating this wasteful care and helps all those who align around value,” noted Jerry Penso, MD, MBA, President and CEO, AMGA.

“There is plenty of evidence that the prices of our health goods and services are high compared to other countries, but price is only one element of the cost of any consumer purchase; quantity is the other. If the quantity results in a bad outcome, or does nothing to improve patient care, it is waste.  The Roadmap shows how to eliminate this drain on resources and scourge to patients. We are glad to be a part of this effort to improve care, weed out waste and lower costs,” said Joel White, President, Council for Affordable Health Coverage.

“These are extraordinarily challenging times for America’s health care providers.  It has always been important to devote resources toward high-quality care and optimal patient outcomes. In the era of COVID-19, when those resources are being stretched thin, eliminating low-value care is now an imperative. This Roadmap should be viewed as a valuable tool to ensure that dollars are being spent as effectively as possible,” noted Mary R. Grealy, President, Healthcare Leadership Council.

“The COVID-19 era has turned the health care environment on its head. As people have reduced their utilization of all health care services, we’re seeing reductions in both high- and low-value care. Going forward, it will be critical for us to understand what is low-value care while educating our people so they continue to pursue appropriate care that supports and sustains their health and well-being,” said Michael Thompson, President and CEO, National Alliance of Healthcare Purchaser Coalitions.

Clif Gaus, ScD, President and CEO, National Association of Accountable Care Organizations, said, “Hundreds of billions of dollars every year is wasted on offering patients low-value care, and accountable care organizations (ACOs) represent one of the best ways to eliminate that waste. The roadmap being released today offers ACOs and other provider organizations ways to cut out low-value care, including using alerts in electronic health records systems and analyzing the performance of clinicians. Our health system must do better at prioritizing high-value services, and this Roadmap will help with that.”

“Health care costs too much. Paying for care that doesn’t benefit us is wasteful and could be harmful to patients – physically, mentally and financially. Efforts like the Roadmap to guide stakeholder identification and reduction of low-value care are a valuable step toward improving quality and reducing costs,” said John Rother, President, National Coalition on Health Care.

Eleanor Perfetto, PhD, MS, Executive Vice President of Strategic Initiatives, National Health Council, explained, “Ensuring access to affordable, sustainable, high-value health care is crucial for those with chronic diseases and disabilities. This Roadmap will help stakeholders meet this goal by helping people get the care they need and avoid low-value care and unnecessary costs.”

Robert Dubois, MD, PhD, Chief Science Officer and Executive Vice President, National Pharmaceutical Council, said, “If we are going to address how we spend our health care resources, tackling low-value care is a good place to start. Through the Roadmap, we want to help organizations develop strategies to prioritize high-value care that will improve patient health outcomes.”

Incentivizing our health care system to address costly inefficiencies is crucial during this global crisis, especially as high-value therapies to tackle COVID-19 become available. By reducing low-value care and the associated costs, we can create greater opportunities to improve patient outcomes and quality of care while reducing spending. Taking necessary steps now to improve efficiency and care delivery across all sectors can help us prepare for the challenges ahead as coronavirus-related costs continue to rise.