Table. Demand-Side and Supply-Side Interventions to Reduce Low-Value Care.

Mechanism and Policy	Description	Pros	Cons
Demand-side mechanisms
Incentives
Patient cost sharing	Encourages consumers to internalize service costs	Reduces overall health care use; does not require service-level measurement of overuse	Patients do not discriminate between effective and low-value care; potentially harmful for vulnerable groups
Value-based insurance design	Communicates relative value of services to consumers through differential cost sharing, discouraging low-value care while promoting effective care	Successfully used to encourage effective care	No evidence regarding effect on overuse; requires complex benefit design, varying payment rates, and adequate appeal process
Information
Patient education	Supports patients to make informed decisions based on service value, possibly through structured shared decision making, use of decision aids, or public education campaigns	Decision aids have been shown to reduce elective procedures; patient education has been shown to reduce overuse of benzodiazepines; little risk of adverse consequences	Depends on precise population targeting, health literacy, and patient engagement and activation
Provider report cards	Gives patients or referring physicians value profiles of hospitals or clinicians; promotes competition through publicly available data on low-value care	Public reporting may draw further attention to and motivate physicians to address overuse	Little evidence that patients use quality data to choose providers; requires precise measurement and effective dissemination
Supply-side mechanisms
Incentives
Pay for performance	Encourages providers to consider value of health care services with bonuses for reducing low-value care	Effective at priority setting; encourages physicians to focus on most harmful or costly forms of overuse	Requires precise measurement; blunt instruments may reduce use of effective care; narrow focus on a limited set of services
Prior authorization	Requires approval from health plan to use service that may be low-value	Systems already in place for most insurers	Requires complex design; potentially reduces physician autonomy
Risk sharing	Encourages providers to consider value of services delivered, because of financial exposure for costs incurred (e.g., shared savings, capitation, bundled payments)	Does not require precise measurement; preserves physician autonomy; encourages provider-level use of other mechanisms; physician practices with capitated payment have been shown to be more likely to measure overuse	May reduce use of effective services; may foster patient backlash
Information
Clinical decision support	Supports clinicians with evidence-based care cues and cost information within electronic health record	Shown to improve performance for some targets, including appropriateness of outpatient imaging	Requires complex design and updating; under fee-for-service system, there is little financial incentive to invest in it
Clinician education	Supports clinicians with continuing education on evidence-based care and cost-conscious care delivery	Success depends on educational intervention; use of clinical pathways has been shown to reduce costs and improve outcomes; little risk of adverse consequences	Little evidence regarding effect on overuse
Clinician feedback	Supports clinicians with feedback on use of low-value care, suggestions for change, achievable benchmarks, and tools for improvement (e.g., Lean, Six Sigma)	Shown to modestly improve use of effective services, especially among poor performers	Little evidence regarding effect on overuse