Imagining a World Without Low Value Care

Researchers, policy experts, practicing physicians, funders and other key stakeholders gathered in Washington, DC in October 2019 to plan a route to the ambitious goal of radically reducing low value care. The discussion focused both on the tools that could enable this change (e.g., measurement and implementation strategies) and how health systems, physicians and others might decide to adopt them (e.g., culture change, alignment of incentives). By the end of the day, significant elements of a five-year agenda became clear. Academy Health, the American Board of Medicine Foundation and the Donaghue Foundation convened the summit as part of a partnership grant which provides support to the Academy Health’s Research Community to Reduce Low Value Care. The summit was held at the Kaiser Permanente Center for Total Health. Kaiser and the Veteran’s Administration collaborated with the conveners in hosting the meeting.

The Summit

Lisa Simpson, MB, BCh, MPH, FAAP, President and CEO of Academy Health, opened the Summit by providing background and a definition of low value care: “services for which the potential for harm exceeds the possible benefit.” Daniel Wolfson, MHSA, the Executive Vice President and COO of the ABIM Foundation, challenged participants at the start to not only help develop recommendations for eliminating low value care but to work to implement those recommendations when they returned to their institutions. The day-long meeting was highly interactive with short presentations by content experts to tee up key issues, followed by reactor panels and additional input from all the attendees.

The summit featured two rounds of a World Café exercise, where all 85 meeting participants divided into groups. Each group was asked to imagine and articulate an “ideal end state” for eliminating low value care by addressing four key domains: Measurement and Data, What Works to Reduce Low Value Care, Culture Change and Alignment of Financial Incentives. Small groups iteratively brainstormed to identify barriers to and opportunities for making progress in eliminating low value care in each domain and to put forward solutions and identify important players to engage in these efforts.

Lunch time speakers had the whole group looking at the process of reducing low value care through frameworks used to create and sustain transformation change. The final sessions of the day included group report from the World Cafe exercises and a panel whose members each offered their views about the most important priorities moving forward to reduce low value care that would engage players patients, providers, purchasers, researchers, policymakers, data managers, and funders in substantive ways.

What’s Next

Several of the Summit presenters have begun to work together to prepare a paper for publication which will summarize key discussion points that came from the Summit, share existing evidence on those topics and make recommendations that came from the collective input and expertise of all the Summit participants on how to make more significant strides in eliminating low value care. Academy Health, ABIM Foundation and Donaghue will be using what we have learned from the Summit to help guide decisions about future priorities in our partnership supporting the Research Community on Low Value Care. For Donaghue, the Summit provided a wealth of good ideas for us to consider as we look ahead to the 2020 call for proposals to our Greater Value Portfolio grant program. The goal of the GVP program is to test approaches and tools that organizations can readily use to improve the value of the healthcare they provide to patients and communities.