Choosing Wisely® An Initiative of the ABIM Foundation

Cassie Dictus Judy Richardson, MD

Outline

Overview of campaign – Impetus and materials available

The OMA’s focus and available support– Conversations and the “5 Questions”

Current and future actions and implementations

Pacific Source Clinical Advisory Panel’s story

Note

Please feel free to type questions & comments as we go. We will pause for discussion/Q and A throughout.

Choosing Wisely

Choosing 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.

http://www.choosingwisely.org/wp-content/uploads/2013/09/Choosing-Wisely-One-Pager.pdf

Choosing Wisely

“The wise start with the whys.”

Background

Berwick DM, Hackbarth AD. Eliminating Waste in US Health Care. JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362.

Overtreatment = $158 - $226 billion in 2011

Patient Safety

Three types of risks for screenings:

1. Procedure itself (radiation)

2. Imprecision (false-positives & negatives)

3. Treatment of non-clinically significant conditions (overdiagnosis)

http://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/cancer-screening

Physician Charter

A Commitment to Professional competence Honesty with patients Patient confidentiality Maintaining appropriate relations

with patients Improving quality of care Improving access to care A just distribution of finite

resources Scientific knowledge Maintaining trust by managing

conflicts of interest Professional responsibilities

Fundamental Principles• Primacy of patient welfare • Patient autonomy • Social justice

http://www.abimfoundation.org/Professionalism/Physician-Charter.aspx

Barriers

Why Are Overuse and Misuse So Important?

• Potential for patient harm• Public health implications• Missed opportunity for more effective

care• Waste of precious resources

- Our patients time- Our time- Cost

Thoughts?

How do the ideas of waste, value and patient safety resonate?- Personally?- With your CCO’s focus?

Do you feel comfortable talking about these issues?

Sparking Conversations

Lists of “Top 5 Things Physicians and Patients Should Question”:

– Evidences indicates unnecessary – Frequent and/or costly ($ or harm)– Not usually controversial (“Top 5 top $5

Billion”)

Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” Lists Top $5 Billion. Arch Intern Med. 2011;171(20):1858-1859. doi:10.1001/archinternmed.2011.501.

Top 5 Lists

http://cepac.icer-review.org/wp-content/uploads/2014/03/Prioritizing-Opportunities-for-Reducing-Inappropriate-Care-in-New-England_ACOG.pdf

Evidence

Sparking Conversations

Consumer Reports created corresponding patient-centered materials:

– 60 Pamphlet Topics (Plain English & Spanish)

– Posters, Wallet-card– Videos, PSA

Patient Pamphlet

Patient Pamphlet

The gift that keeps…

9 societies in 2012 --> 60+ societies today

SEARCH

FUNCTION

www.choosingwisely.org

http://www.aafp.org/journals/afp/authors/ebm-toolkit/resources/choosing-wisely.html

But, “Choosing Wisely” is a game-changer. The advice comes not from payers or politicos, but from pedigreed physician groups. The specialty societies are not guessing; their lists of procedures contain copious scientific citations supporting the claims of overuse.

Thoughts?

What do you think about the materials so far?

OMA Campaign

Two-year grant:– Awareness and education– Toolkits tailored by audience– Task force --> Focus on conversations

www.consumerhealthchoices.org/OMA

Conversation Tool

OMA Campaign

Patient Wallet Card

We can help with…

CustomizationPrintingTraining and educationBest practicesConnection to larger CW networkTechnical assistance

http://www.choosingwisely.org/resources/modules/

Communication Tips

1. Elicit concerns

2. Empathize

3. Recommend

4. Provide written information

5. Establish a plan

Thoughts?

Do you think this would be a helpful patient-engagement and shared-decision making tool?

Actions

Review the recommendations

Start a conversationPromotionUse materials

http://blog.abimfoundation.org/

Quality improvement projects

Employee programsEducation

integrationEHR integration

Website Button

KUMP-TV & PSA

Help Promote:- Website button- Blogs, newsletters, social media, videos,

magazine articles- Presentations

Social Media

I've asked what happens when I don't do anything. So far my doctors have been great. GO BEAV's!!!

Communication Tips

Social Media

Commonly used medical tests and procedures are not always needed. In fact, sometimes more care can be harmful. Talking with your doctor is the best way to make sure you are choosing your care wisely.

Have you used these questions with your doctor? Can you think of a time that one or more of these questions might have been useful? Please share your story below.

Social Media

“I have not used these questions during a doctor visit. But I will sure do that in the future to help gage whether I'm getting the best care for myself. Thanks!”

Social Media

“I've asked what happens when I don't do anything. So far my doctors have been great. GO BEAV's!!!”

Oregon’s CCOs

HB 2859 – Task Force on Individual Responsibility and Health Engagement Recommendations: Value-Based Benefit DesignShared Decision-Making Tools

http://www.oregon.gov/OHA/OHPR/Pages/irhe.aspx

Clinical Advisory Panel’s Role

• CAP: a 17 member panel composed of physicians from a variety of fields, physical therapists, pharmacists, nurse practitioners

• Charter: - To review guidelines & prescribing practices- To help providers in our CCO provide better care- Review quality incentive measure performance &

provide feedback to providers- Review some transformation project proposals- Think about ways in which we can reduce waste

Clinical Advisory Panel’s Role

• The OMA and Choosing Wisely have given us better tools to talk with patients, encouraging us to use the five questions and help our patients be more informed:

- Find out where the patient is coming from – what are they expecting? Is that reasonable?

- Explain your reasons.- Make it clear that we are on the same side!- Make the plan clear, review red-flag signs and

symptoms

Clinical Advisory Panel’s Role

• CAP: a 17 member panel composed of physicians from a variety of fields, physical therapists, pharmacists, nurse practitioners

• Charter: - To review guidelines & prescribing practices- To help providers in our CCO provide better care- Review quality incentive measure performance &

provide feedback to providers- Review some transformation project proposals- Think about ways in which we can reduce waste

Thoughts?

Best way to disseminate to your:- CCO?- CAC?- CAP?- Members?- Providers?

Contact Information

Website: www.consumerhealthchoices.org/oma

Facebook: Oregon Medical AssociationTwitter: @ORMedicine

Cassie Dictus, Program Coordinatorcassandra@theOMA.org, 503.619.8000