Low-Value Care De-implementation: Practices for Systemwide Reduction

Despite a growing body of evidence documenting the problem of low-value care, our understanding of how to effectively reduce or eliminate it remains limited. Through semistructured interviews with U.S. health care organizations with demonstrated experience and success in low-value care reduction, the authors sought to elucidate how different stakeholders across the system approach low-value care de-implementation in practice and the key strategies and actions used. The analysis identified four key phases of low-value care de-implementation: (1) plan and assemble, (2) identify and assess, (3) de-implement, and (4) evaluate and disseminate. De-implementation is an iterative, multiphased, multicomponent process marked by ongoing learning and feedback loops. Each organization approached low-value care de-implementation with a strong orientation toward experimentation and continuous improvement and as a central tenet of a broader organizational mission to improve health and health care value. To combat the complex drivers that facilitate and sustain low-value care provision, organizations adopted a range of strategies, resources, and tools to inform, implement, and drive their de-implementation efforts. Such features included, but were not limited to, senior leadership support and aligning low-value care initiatives with unifying organizational values and priorities; physician leadership and empowerment; de-implementation infrastructure supports across people, data, and technology; education and engagement opportunities for providers, patients, and staff; data-driven techniques to measure and track low-value care, benchmark performance, and embed or link de-implementation targets within payment, network design, and care pathways; and ongoing relations with internal teams and external stakeholders and partners to disseminate and scale de-implementation best practices. While health care organizations are complex and unique - with their own culture, workforce mix, resources, and priorities - these identified experiences and practices from organizations successful in de-implementation can inform and empower others across the health care landscape to act, innovate, and move the needle on systemwide low-value care reduction.