High-Value Care
By Lakmali Ranathunga, MD, chief medical officer, Miami Valley Hospital North, Upper Valley Medical Center
High-value care stands as one of the commonly discussed topics in health care, aiming to minimize costs and optimize patient outcomes while steering clear of unnecessary and potentially harmful interventions, including tests and procedures. It prioritizes delivering top-quality care tailored to individual patient needs, striving for the best possible results within specific circumstances and ensuring excellence in care.
In the realm of health care economics, the United States faces a significant challenge as it is projected to spend about a fifth of its GDP on health care by 2026; despite this substantial investment, outcomes and performance lag behind other developed countries. The Commonwealth Fund's assessment places the U.S. health system at the bottom among its Western counterparts, highlighting deficiencies in access, administrative efficiency, equity, and overall outcomes. This situation underscores the urgent need to shift focus toward high-value care.
The concept of high-value care has gained prominence in medical education and is recognized as a fundamental skill by professional bodies. Several influential organizations, such as the American Board of Internal Medicine and the American College of Physicians, have initiated efforts to ensure patients receive exemplary care. Initiatives like “Choosing Wisely” from the ABIM Foundation have made significant strides in encouraging discussions in the medical community around avoiding unnecessary tests and treatments that offer little benefit to patients.
Despite these concerted efforts, instances of low-value care persist in daily clinical practice. Health care providers must prioritize achieving optimal patient outcomes while curbing unnecessary costs and avoiding wasteful practices. This involves delivering effective, evidence-based care in both inpatient and outpatient settings. For instance, reducing unnecessary daily lab tests, telemetry without indication, and imaging procedures like CT PE protocols and MRIs without clear indications. Another example is prescribing antibiotics for potential viral illnesses and aggressive interventions in terminal patients without focusing on palliative care or improving quality of life. Every unnecessary test ordered delays the care of a patient who genuinely needs the procedure due to limited resources.
Patients also play a pivotal role in ensuring high-value care. Asking informed questions about the risks, benefits, and alternatives to proposed tests or treatments fosters shared decision-making between patients and physicians. This approach encourages a collaborative effort to pursue high-value care aligned with patient preferences and needs.
To combat the prevalence of low-value care, strategies span a broad spectrum. These include enhancing comparative effectiveness research, educating health care providers, implementing non-financial incentives, setting clear reduction goals, promoting patient engagement in decision-making, and encouraging medical harm reporting. The ABIM initiative “Choosing Wisely” serves as a catalyst, fostering dialogue between physicians and patients to minimize the utilization of low-value care.
Read more information on the ABIM Foundation Choosing Wisely initiative.
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