What is “low-value” care, and how can its utilization among vulnerable populations be reduced? A team of healthcare policy researchers has analyzed the situation, and produced some recommendations around it.
In the Health Affairs Blog, Alyna Chien and Romana Hasnain-Wynia on June 10 published their analysis, entitled “Reducing Low-Value Care Among Vulnerable Populations.”
And what is low-value care, to begin with? The researchers write that “Low-value care (also known as unnecessary, overused, or inappropriate services) is care in which the potential for harm exceeds the possible benefits. In the past, “harms” have focused on undesired clinical consequences, but there is increasing awareness that harms extend beyond medical practices and into the emotional and financial spheres of patients’ lives. Such harms, in turn, can further diminish health. To date, most efforts to reduce low-value care have focused on specific services without particular attention to populations in need, such as vulnerable populations.”
What’s more, they write, “In addition to receiving lower-quality care than other populations, vulnerable populations also are more likely to receive low-value care. Racial and ethnic minorities insured by Medicare were more likely than whites to receive a number of inappropriate services, such as antipsychotics for patients with dementia, bone density and vitamin D screening, and cardiac testing before cataract and other non-cardiac surgeries. Medicaid and uninsured patients have also been shown to receive low-value services. To improve the health of vulnerable populations, our nation will need an explicit and effective strategy for reducing low-value services in vulnerable populations and ultimately replacing these services with high-value care.”
So, what can healthcare leaders do about this policy problem? “Different stakeholders within health care have different roles to play in reducing low-value care for vulnerable populations,” the researchers write. “For example, health systems could introduce general messaging about low-value care and its potential to cause harm. Researchers could experiment with how to put messaging into terms that the general public can relate to—for instance, discussing its impact on function, employment, or pain, instead of using medical terms such as morbidity, mortality, and disease-free progression. Clinicians could identifying the times when such messaging could be helpful or stigmatizing. To reach vulnerable populations and to help clinicians reduce low-value care at the frontlines, health care leaders and their organizations could invest in programs that supplement standard messages with tailored ones. This is not a matter of just simplifying messages (although that can be an important component of a larger intervention) but of genuinely improving an organization’s ability to engage vulnerable populations in effective, health-promoting activities and treatments.”
