Patient, provider, and health system characteristics leading to the delivery of low value health care services and outcomes of an intervention for mitigating low value care.

The United States spends more on health care than any other country, and Medicare accounted for nearly one-quarter of total personal health care spending in 2019. Waste within the health care system in the United States is estimated to represent approximately 25% of total U.S. health care expenditures. Low value care includes health care services that provide little or no benefit to patients, have potential to cause harm, incur unnecessary costs to patients, or waste limited healthcare resources. Low value care is estimated to represent roughly 10% of total health care waste, or between $75.7 billion and $101.2 billion dollars annually. While several professional organizations, such as the United States Preventive Services Task Force (USPSTF), have sought to address low value care through the publication of evidence-based recommended care guidelines, the prevalence of low value care has persisted. This dissertation provides a summary of the existing literature on patient, provider, and health system-level drivers of low value care. A framework consisting of these drivers is developed and then applied to assess the patient, provider, and health system characteristics leading to the delivery of low value imaging services for a population of Medicare beneficiaries covered under a major national health insurer in the United States. Taking into consideration those characteristics associated with low value care, the effect of prior authorization for mitigating low value revascularizations is also assessed. Associations between several patient, provider, and health system characteristics and low value imaging services were observed. Specifically, greater low value care was observed for Medicare beneficiaries 70 years and older, beneficiaries with greater than $1,000 in annual health care spending, beneficiaries identified as male, non-white, or residing in the South, and health care providers who practice in the South. Adjusting for characteristics with known associations with low value care use, the effect of prior authorization to mitigate low value revascularizations produced positive, albeit statistically insignificant, cost savings. These results provide a greater understanding of the characteristics associated with low value care and help to inform future research and policy strategies for evaluating and implementing interventions for reducing low value health care services.