Virginia initiative modestly reduced use of low-value care

This quality improvement study used a difference-in-differences analysis to compare 6 health systems participating in Smarter Care Virginia with 12 control systems. It included 17,223 clinicians and 4.5 million patients eligible for at least one of nine selected low-value services. The intervention combined health system financial support, clinician education and quarterly peer-comparison scorecards. Utilization in 2019 was compared with 2021–2022, with outcomes including use of any selected service, adverse events and per-capita spending on those services.

The proportion of patients receiving at least one low-value service fell from 10.5% to 8.5% in intervention systems and from 10.7% to 9.1% in control systems. The initiative was associated with a 10.4% relative reduction, equivalent to an absolute reduction of 1.1 percentage points (95% CI, −2.1 to −0.1; P=.04). There was no statistically significant change in adverse events or spending on the nine services.

The findings suggest that a statewide, health-system-led approach can modestly reduce selected low-value care, but the study found no reduction in measured spending and no statistically significant change in adverse events. The results apply to the services assessed and do not establish that the approach would produce larger reductions; the authors note that additional strategies, including payment reform and accountability measures, may be needed.