Choosing Wisely ®

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Choosing Wisely ®. An initiative of the ABIM Foundation Overview of the MiHIA Regional Campaign . The Issues. Waste in Health Care Spending* $750 Billion 30% Unnecessary Care Americans Living Longer, Quality of Life Decreasing U.S.A . ranks 26 out of 34 OECD** Nations - PowerPoint PPT Presentation

Text of Choosing Wisely ®

PowerPoint Presentation

Choosing WiselyAn initiative of the ABIM FoundationOverview of the MiHIA Regional Campaign

Welcome, and thank you for being here today.

My name is (PRESENTER NAME). (Presenter gives brief bio, has the group introduce themselves or their organizations as appropriate.)1The IssuesWaste in Health Care Spending*$750 Billion30% Unnecessary Care

Americans Living Longer, Quality of Life DecreasingU.S.A. ranks 26 out of 34 OECD** Nations

*Estimates from the Institute of Medicine of the National Academies and the Congressional Budget Office**Organizations for Economic Cooperation and Development

2Across the United States, cost is skyrocketing in the current health care system, while quality is going down. Individual members of the health care system striving to make changes, are not able to effect change fast enough. (Does this help soften any potential perceived critique of the medical community?)

Federal estimates put the total waste in health care spending at about $750 billion per year, with up to 30% of provided care labeled as unnecessary

And though Americans are living longer, the length of time we leave with disability is increasing. Out of the 34 OECD nations, the US ranks 26th for quality of life.

Though the idea that more health care is better seems to make intuitive sense, recent research is finding the exact opposite that unnecessary testing is bad for our wallets, and in some cases, more harmful than helpful to our health.

Enter Choosing Wisely.2The Modern Patient 3

How many of us in the room can resonate with this cartoon?

I think its fair to say that one of the additional issues we are facing in our health care system today is the modern patient. Over the past 15 years, thanks to the genesis of the World Wide Web, we have overwhelming access to information like never before.

Brooke Carey, a writer and blogger for the Huffington Post wrote in a recent article about her experience with HPV and a cervical cancer scare. She said, One takeaway from this experience was that the Internet can be a dangerous place to search for medical information. I have since started joking that if you try to self-diagnose using information you find online, you will convince yourself that you are pregnant and have cancer.


While each patient situation is unique, there are times where the requested or recommended testing is simply unnecessary. To begin combating some of the broader health care system issues that I talked about at the beginning of this presentation, we need to focus on changing how we approach the patient-physician interaction, from both sides. 4Choosing Wisely OverviewChoosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices.Choosing Wisely recommendations should not be used to establish coverage decisions or exclusions. Rather, they are meant to spur conversation about what is appropriate and necessary treatment. As each patient situation is unique, physicians and patients should use the recommendations as guidelines to determine an appropriate treatment plan together

5Choosing Wisely is an initiative with laser focus promoting physician-patient conversation to support smart, effective care choices.

The goal of Choosing Wisely is to provide resources and education to encourage dialogue about what is necessary and appropriate treatment for each patient, understanding that each patient situation is unique.5Physician Focus GroupsFocus groups with physicians revealed they:

Recognize there are a lot of unnecessary tests and procedures

Do not see themselves as the problem - responding to patient requests for more tests and procedures

Do not consider themselves stewards of resources

Want to do the right thing for their patients - deliver the best care possible and not cause undue harm

Want to be part of the solution, and terms like wise choices resonated

ABIM Foundation conducted ABIM has deeper dive information if needed


United States specialty societies representing more than 500,000 physicians developed lists ofFive Things Physicians and Patients Should Questionin recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

Choosing Wisely is encouraging a list of 5 overarching questions to ask your doctor before getting any test, treatment, or procedure. 7

Individual lists published by other partners are specific to their subject matter. Here is one example from the American College of Cardiology.


Each list also includes a bibliography, providing the source documentation used to create each list.

Important to understand these are reputable, trusted sources.9

While the previous list example highlights one of many resources available to physicians, lists have also been developed with a consumer focus, including patient-friendly vernacular.


Choosing Wisely has already been highlighted extensively by the media, and continues to receive attention.11

This article, published by The Journal of the American Medical Association, is one example and speaks to the Choosing Wisely campaign intent.

12Choosing Wisely Partners

This is the initial list of Choosing Wisely partner societies who have released Top 5 resources, and this group continues to grow there are well over 60 societies who have joined the campaign.

34 additional societies will be releasing lists in the remainder of 2013 and early 2014 a full list can be found here:

13Choosing Wisely GranteesRegional CollaborativesBetter Health Greater ClevelandHealthInsight UtahInstitute for Clinical Systems Improvement and Minnesota Health Action GroupIowa Healthcare CollaborativeMaine Quality CountsMassachusetts Health Quality PartnersMichigan Health Information AlliancePuget Sound Health AllianceWisconsin Collaborative for Healthcare QualitySpecialty/State Medical SocietiesAmerican Academy of Hospice and Palliative MedicineAmerican Academy of OphthalmologyAmerican College of PhysiciansAmerican Society for Clinical PathologyAmerican Society of EchocardiographyAmerican Society of Nuclear Cardiology and Massachusetts Medical SocietyMinnesota Medical AssociationOregon Medical AssociationSociety of Hospital MedicineTennessee Medical AssociationTexas Medical AssociationWashington State Medical Association14In early 2013, the ABIM Foundation, with support from the Robert Wood Johnson Foundation, selected 21 organizations nationally to promote the Choosing Wisely campaign. This elect group includes one of our own, from within our region the Michigan Health Information Alliance, or MiHIA.


ABOUT MiHIAMichigan Health Information Alliance, Inc.

Regional community collaboration working to achieve a community of health excellence for the 14-county region it serves

Based on a core belief that solutions to our health and health care problems can be found and designed at a regional level, accelerating regional competitive advantage and sustainability.

Briefly overview slide paraphrasing, not reading directly.

What does this mean?

Number one were a multi-stakeholder collaboration, which is unique. No one else in our region is convening parties from all aspects of health and health care providers, health plans, employers, physicians, etc. and bringing them all to the table. MiHIA is doing this.

Number two health and health care issues are not going to be solved on the national stage. Waiting for that to happen is not something we can afford to do. Our goal is to move quickly and efficiently at a regional level to start driving change. In doing this, we benefit our region on multiple levels. For individuals, we improve health and quality of life.For employers, we improve the workforce, we create a community with recruitment power, we innovate to reduce health related expenses and create a better bottom line.For foundations, convening parties for efficiency can reduce donor fatigue and total dollars given in support of multiple health-related initiatives.

16Our Committed Local PartnersAetnaBlue Cross Blue ShieldCentral Michigan University College of MedicineCentral Michigan University Public RadioCovenant HealthCareThe Dow Chemical CompanyEzekiel ProjectGratiot Family PracticeHealth Delivery, Inc.Hospital Council of East Central Michigan Midland Medical SocietyMidMichigan HealthPublic Health Departments Midland, CMDHD, Saginaw, and BaySaginaw County Medical SocietySaginaw Valley State University School of Nursing


Delivering the Choosing Wisely message requires the same kind of collaborative commitment that MiHIA has modeled in its other initiatives. To this end, we have a list of committed partners locally within our region, who are already helping advance Choosing Wisely in our communities.

17Implementation Plans: TargetsProviders


ConsumersHospitals, FQHCs, IndependentLocal Medical SocietiesState Medical Specialty AssociationsHealth plansHuman ResourcesOccupational HealthPublic