Low vs High Value Care

Low-value care are healthcare services that have little or no clinical benefit.¹ In 2009, the Institute of Medicine (IOM) estimated the U.S. wasted $340 billion on unnecessary healthcare services and inefficiently delivered services—that would be $501 billion in 2018 dollars.² This low-value care can harm patients directly by putting them at risk from unnecessary procedures and testing, or by diverting resources away from high-value care. Strategies that could reduce the provision of this care include increasing comparative effectiveness research, provider education and non-financial incentives, establishing widely acknowledged goals for reductions, provider payment reform, patient shared decision making and medical harm reporting. Choosing Wisely is a campaign to encourage conversations between physicians and patients to reduce the use of low-value care. However, there is a lack of consensus on how to incorporate clinical nuance, patient preference and priorities, and cost-benefit tradeoffs into provider and consumer discussion to reduce low-value care in healthcare.³  See this page for more on low-value care.

High-Value care. Ideally all clinical care would have a net clinical benefit but certain forms of care—like preventive care—can reliably and predictably provide substantial individual and population health benefits. For example, the National Commission on Prevention Priorities released a list in 2016 of 28 high-value services with strong evidence of effectiveness, population-wide health impact and cost-effectiveness.⁴ Highest ranked services included immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults; alcohol misuse screening with brief intervention, discussing aspirin use with high-risk adults, colorectal cancer screening, cervical cancer screening, chlamydia and gonorrhea screening, cholesterol screening, hypertension screening, obesity screening and more.