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Reducing Overuse by Healthcare Systems: A Positive Deviance Analysis.

Michael I Ellenbogen1, Aaron A Wiegand2, J Matthew Austin3,4

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High-value healthcare systems reduce overuse by fostering professional practice cultures and engaging patients. Financial structures also play a key role in encouraging high-value care delivery.

Keywords:
healthcare systemslow-value carepositive deviance

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Quality Improvement

Background:

  • Healthcare delivery in the USA is increasingly consolidated within large healthcare systems.
  • The role of these systems in driving or preventing healthcare service overutilization is not well understood.

Purpose of the Study:

  • To identify characteristics of high-value healthcare systems that successfully avoid overuse of services.
  • To validate a theoretical framework for understanding overuse drivers within these systems.

Main Methods:

  • Identified "positive deviant" health systems with low overuse rates using an Overuse Index.
  • Conducted semi-structured interviews with executive leaders from diverse healthcare systems.
  • Analyzed interview data using constant comparative techniques to identify emergent themes.

Main Results:

  • Leaders emphasized creating a culture of professional practice and modifying clinician attitudes to promote high-value care.
  • Patient perceptions of healthcare consumption and population characteristics were identified as factors influencing high-value medicine.
  • Quality metrics, insurance plan ownership, and alternative payment models were cited as encouragements for overuse avoidance.

Conclusions:

  • Qualitative analysis supports existing literature on overuse frameworks within healthcare systems.
  • Healthcare system leaders highlighted financial structures as a significant factor in reducing overuse and promoting high-value care.