LVCTF Newsletter | September 2025 Update - Value Based Insurance Design Health

In this issue:

CMS chooses 6 states for WISeR Model
Advancing the Field of De-implementation: Perspectives on LV Clinical Preventive Services
Effectiveness of different de-implementation strategies in primary care
VA Clinicians’ Perspectives on Low-Value Health Service Use in the Veterans Health Admin
Choosing wisely and climate crisis: reducing lvc as a strategy to curb environmental impact
Evaluating the Total Healthcare Cost of Inappropriately Ordered Thyroid Ultrasounds

CMS chooses 6 states for WISeR Model

The CMS Innovation Center will test prior authorization for Medicare coverage of selected services in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Medicare administrative contractors in the states chosen for the Wasteful and Inappropriate Service Reduction demonstration project already have coverage policies for the targeted services and will refer to those policies when deciding whether to approve coverage. Read more.

Advancing the Field of De-implementation: Perspectives on Low-Value Clinical Preventive Services

A recent AJPM article gathers expert input to explore how “de-implementation” strategies might reduce the use of low-value clinical preventive services. It finds that existing frameworks are few, empirical studies are rare, and key obstacles include confusing terminology, potential unintended harms, and limited patient and community engagement. The findings point toward the need for clearer definitions, more research on specific preventive services, and policies that meaningfully involve patients and families in reducing unhelpful care.

Effectiveness of different de-implementation strategies in primary care: systematic review and meta-analysis

A recent BMJ Medicine article presents a systematic review and meta-analysis of 140 randomized trials assessing de-implementation strategies in primary care aimed at reducing low-value tests, treatments, and services. The study finds moderate certainty that combining provider education with audit and feedback reduces low-value care by about 23%, while single strategies (like only education or only audit/feedback) show smaller, less consistent effects. These findings suggest that policy efforts should prioritize multifaceted interventions to more reliably reduce wasteful care, helping improve quality and reduce costs.

VA Clinicians’ Perspectives on Low-Value Health Service Use in the Veterans Health Administration: A Qualitative Study

A recent JGIM article presents a qualitative study interviewing 65 VA clinicians from 46 medical centers about why low-value health services persist and how to reduce them. It identifies key drivers—like patient expectations, referral pressures, and resource constraints—and suggests several strategies, including better access to VA health care, clearer best practices, improved electronic health record tools, and a stronger organizational culture around value. These insights are highly relevant for policy efforts aiming to cut wasteful care, boost care quality, and ensure resources are better used for interventions that truly help patients.

Choosing wisely and climate crisis: reducing low-value care as a strategy to curb healthcare environmental impact

This Internal and Emergency Medicine letter to the editor argues that the Choosing Wisely campaign’s efforts to reduce low-value medical care—like unnecessary imaging and antibiotic use—can also lower healthcare’s significant environmental footprint, including greenhouse gas emissions and pharmaceutical pollution. This approach aligns clinical effectiveness with ecological sustainability, offering a pathway where “doing less, when appropriate, is not just good medicine, it is also good planetary stewardship”.

Evaluating the Total Healthcare Cost of Inappropriately Ordered Thyroid Ultrasounds

A recent Journal of the Endocrine Society article assessed the cost impact of inappropriately ordered thyroid ultrasounds (TUS) using data from four Mayo Clinic sites between 2017-2021. Though inappropriate TUS patients had similar overall healthcare costs to those with appropriate indications ($13,748 vs. $14,257 at one year), the cascade of downstream procedures—like biopsies and thyroidectomies—added at least $576,000 in direct procedural costs in the cohort studied. The findings suggest that targeting low-value imaging presents a real opportunity for cost savings and resource optimization in health policy.