As much as $340 billion is being spent on low-value or unnecessary health care alone in the United States. While that makes finding and eliminating low-value care critical, it can be difficult to identify. And identifying low-value care is only the first step; it is often more daunting to determine how to eliminate it.

To tackle this issue, the Going Below The Surface Forum, in conjunction with AcademyHealth and the National Pharmaceutical Council (NPC), hosted a Jan. 15 webinar on low-value care. NPC’s Robert Dubois, MD, PhD, moderated a discussion on the topic with the Institute for Healthcare Systems’ Jennifer Perloff, MPA, PhD; AcademyHealth’s Lisa Simpson, MB, BCh, MPH, FAAP; and Duke University’s Corinna Sorenson, PhD, MHSA, MPH.

Low-value care – defined as care that offers no benefits over less costly alternatives, a potentially harmful service, or services within the course of an illness that are duplicative or unnecessary – can be hard to spot, especially when data about the economic impact of a service or treatment is limited.

The speakers discussed one potential way to combat this issue: a taxonomy of low-value care. For example, certain services should “never” be done – such as routine vitamin D testing – as the expenditures largely outweigh the benefits. Similarly, some services should “rarely” take place, such as testing before low-risk surgery, as they are beneficial for certain patients but not others. These treatments or tests should be determined on a case-by-case basis. Lastly, there should be services that may be useful once, but fall into a category of “never repeated” interventions, including genetic testing. As a society, we must begin to have a dialogue that includes such taxonomies to help us speak more clearly about what’s meant by low-value care.

While estimates on low-value care use and spending allow us to understand the scope of the problem, identifying where these issues occur and at what cost can better inform de-implementation priorities and strategies.

That means stakeholders need new guidance or tools – as well as the awareness of the tools that do exist – to prioritize which areas of low-value care to tackle. Additionally, stakeholders must continue to ask the tough questions about the “never,” “rarely” and “never repeated” services. The Going Below The Surface Forum is working on a roadmap to navigate these issues and better arm stakeholders to address low-value care at a macro level, which will be rolled out in early spring. In the meantime, stay informed and up-to-date on health spending issues by following along on social media using #GoingBelowtheSurface and subscribing to the Going Below The Surface enewsletter.