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

NEJM Catalyst Innovations in Care Delivery 2022; 0
Corinna Sorenson, PhD, MHSA, MPH, Mark Japinga, MPAff, and Hannah Crook

Published April 20, 2022


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.

Originally published at https://catalyst.nejm.org on April 20, 2022.

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