Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Trends in Low-Value Care Following a Payer-Initiated Audit and Feedback Intervention: A Retrospective Analysis in Hospitals With Varying Payment Models 1 9 4909 10.34172/ijhpm.9060 EN Vera De Weerdt Department of Health Economics, School of Business and Economics, Vrije Universiteit, Amsterdam, The Netherlands Amsterdam University Medical Center, Amsterdam, The Netherlands 0000-0003-3644-620X Xander Koolman Department of Health Economics, School of Business and Economics, Vrije Universiteit, Amsterdam, The Netherlands 0000-0003-4225-8854 Hanna C. Willems Department of Geriatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands Leading the Change, Zorgevaluatie Nederland, The Netherlands 0000-0002-3166-6951 Sjoerd Repping Amsterdam University Medical Center, Amsterdam, The Netherlands National Healthcare Institute, Diemen, The Netherlands 0000-0002-6959-149X Piet A. Stam Department of Health Economics, School of Business and Economics, Vrije Universiteit, Amsterdam, The Netherlands 0000-0003-3680-6391 Jacques Van Limbeek ONVZ Health Insurance, Houten, The Netherlands Eric J.E. Van Der Hijden Department of Health Economics, School of Business and Economics, Vrije Universiteit, Amsterdam, The Netherlands Zilveren Kruis Health Insurance, Zeist, The Netherlands 0000-0003-3359-2711 Journal Article 2025 02 28 Background Reducing low-value care (LVC) remains a significant challenge in healthcare systems, despite efforts for de-implementation. To facilitate de-implementation payers may use provider Audit & Feedback (A&F). This study aims to examine trends in LVC following a payer-initiated A&F program, and to explore whether this association varies across hospital payment models.Methods Multilevel logistic regression was used to examine the trend in LVC in hospitals, its correlation with an A&F intervention, and whether this varied with payment models including fee-for-service (FFS), global budget (GB), cost ceiling (CC) and gradual tariff (GT). To assess this, we used hospital level claims data from a large nationwide Dutch health insurer on 70 hospitals in the period 2017-2022. The primary outcome was the yearly proportion of LVC per hospital. Independent variables were time, market share and payment models. We hypothesized that payer-initiated A&F had a stronger impact in hospitals were the payer had a larger market share, and that the effect would be stronger still for hospitals with financial incentives to reduce production.Results LVC showed a small, but significant decline over time (odds ratio [OR]: 0.98; 95% confidence level [CI]: 0.98-0.99). LVC tended to be higher in hospitals where the payer had a higher market share (OR: 1.03; 95% CI: 1.00-1.05). The CC model was associated with an increase in LVC (OR: 1.11; 95% CI: 0.99–1.03). The other payment models were associated with a decrease in LVC. The FFS model exhibited the smallest reduction in LVC (OR: 0.98; 95% CI: 0.98-0.99), and the GT model (OR: 1.01; 95% CI: 0.99-1.03) showed similar patterns in LVC. The GB model was associated with the largest reduction in LVC (OR: 0.94; 95% CI: 0.91-0.97).Conclusion By itself A&F did not clearly contribute to the decline of the proportion of LVC; combined with volumeconstraining financial incentives, it was associated with larger reductions. https://www.ijhpm.com/article_4909_457ded6f20b28feb21b9bca73c498671.pdf