Health systems face considerable pressures, with great care often yielding minimal benefits and innovations added to outdated methods. Learn how a value-based, pathway-level approach leads to better outcomes, smarter investments, and sustainable healthcare
Pressure on the healthcare system is increasing. Rising demand, workforce shortages, and clinical complexity are straining services. In this environment, two forces shape the reality of daily care: the persistence of low-value activities and the rapid growth of innovation. These forces often interact with each other. Low-value care absorbs scarce resources, while innovations such as AI-assisted diagnostics and digitally-enabled care are often layered onto existing systems without addressing underlying inefficiencies. For health systems to meet future challenges, they must design innovations that replace low-value care, rather than simply adding to it.
Impact of low-value care
Low-value care refers to tests, treatments, and processes that provide little or no benefit to the patient. This includes overuse, misuse, underuse, and unwarranted variation, and can account for one-fifth of global health spending. The consequences are familiar: avoidable harm and wasted resources. Low-value care also diverts investment from prevention and high-value care.
Despite years of attention, progress in reducing low-value care has been slow. Much effort is currently being put into identifying interventions to avoid through NICE’s ‘what not to do’ recommendations, Choosing Wisely™ lists and professional guidelines. These efforts are important, but they operate at a single decision level. In reality, care is primarily delivered through pathways that span multiple professionals, settings, and decision points. While each step seems reasonable on its own, the entire pathway may provide limited value, especially if innovative technology is added without redesigning the pathway itself. Therefore, low-value care is not simply a collection of poor decisions. It’s a feature of the system design.
At the same time, health systems are investing heavily in innovation. New diagnostic and digital technologies are expected to improve efficiency and help manage demand. But without redesigning the pathways through which these innovations are introduced, there is a risk that they will simply be superimposed on existing patterns of care. The result is often additional costs, limited improvement in outcomes, and increased pressure on staff operating increasingly complex systems.
The central question is not whether innovation is good or bad. The question is whether innovation can improve outcomes across pathways and stop doing things that provide low value.
Redesigning the path to value
A values-based approach provides a practical method. Value-based health care (VBHC) emphasizes outcomes that are important to patients relative to the resources needed to achieve those outcomes. This shifts attention from volume to impact and from individual interventions to pathway performance.
In practice, this means using health outcomes data to understand what works, what doesn’t, and where resources should be reallocated. Interventions that do not contribute to outcomes can be eliminated, redesigned, or replaced, allowing investment in innovations that improve outcomes, adjustments, and patient experiences. For clinicians, this supports work that makes a meaningful difference for patients.
However, this change is difficult to achieve. Health systems are far better off adding new interventions than stopping existing ones. Even well-evidenced innovations struggle to be effective when introduced into unaltered channels. This is particularly true for people who live with multiple long-term conditions and often experience fragmented care across multiple services. Without coordination, duplication and unnecessary treatments become more common.
actually make a difference
Reducing low-value care requires more than clinical guidance. It requires behavioral, organizational and cultural change. Clinicians operate within a system shaped by incentives, workflows, and norms. Progress therefore depends on aligning incentives with outcomes, providing decision support, and leveraging outcome audits and insights to power change. It also relies on interoperable data and implementation approaches that evaluate innovation across pathways rather than individual pilots. Equity must also be central. Low-value care is not evenly distributed across populations, and poorly designed interventions risk widening existing inequalities.
“Innovation creates value only when it replaces lower-value treatments. Unnecessary tests and treatments have carbon costs that can no longer be ignored.”
Environmental demands are also increasing. Unnecessary testing and processing causes waste and emissions. Reducing low-value care not only drives better outcomes and efficiency, but also supports a more environmentally sustainable health system.
For policymakers and system leaders, the message is clear. This means that reducing low-value care and introducing innovation must be done simultaneously. This means investing in key outcome measurements, redesigning pathways around patient needs, and replacing low-value activities with innovation rather than adding them.
Without this change, health systems risk doing more without delivering better. Real progress will depend on redesigning care, removing investment from low-value activities, and ensuring innovation delivers measurable improvements in outcomes that matter to patients.
Policy call to action
Six priorities for delivering value through innovation
- Making results the organizing principle of care
- Innovation required to demonstrate pathway-level impact
- Incorporate non-implementation into any innovation strategy
- Align incentives with value, not quantity
- Prioritize equity and sustainability
- Supporting employees to lead change
Read more
- Porter me. What is value in health care? N Eng J Med 2010;363: 2477–2481.
- OECD. Tackling wasteful spending on health. OECD Publishing; 2017.
- A wise choice. Wise choice campaign. 2024.
- National Institute for Healthcare Excellence (NICE). Recommendations on what not to do. 2016.
- Dunsmore, J., Duncan, E., MacLennan, S. The effectiveness of non-implementation strategies for low-value prescribing in secondary care: a systematic review. Implement Sci Commun 4, 115 (2023).
- Niven DJ, Mrklas KJ, Holodinsky JK Towards an understanding of recruitment discontinuation of other low-value clinical practices: A scoping review. BMC Medicine. 2015;13:255.
