Transcript hrsc-presentation

Choosing Wisely
and
Healthcare Resource
Stewardship Council (HRSC)
PGIP Meeting
December 6, 2013
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Why stewardship? Why now?
• Health care expenditures are increasing at unsustainable rates
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Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011
• There is waste in the health care system—some say as much
as 30%
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Jack Wennberg, Dartmouth Center for the Evaluative Clinical Sciences.
• One third of all physicians acquiesce to patient requests for
tests and procedures—even when they know they are not
necessary
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Campbell EG, et al. Professionalism in medicine: results of a national survey of physicians. Ann
Intern Med. 2007; 147(11):795-802
• Physician decisions account for 80% of all health care
expenditures
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Crosson FJ. Change the microenvironment. Modern Healthcare and The Commonwealth Fund
[Internet]. 2009; Apr 27
Excess Cost Domain Estimates
IOM. The Healthcare Imperative, 2010.
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Overriding Issues in Health Care
• Issue of the decade
starting in 2000: quality
of care and patient
safety
• Issue of the decade
starting in 2010:
decreasing the cost of
care
• Recent initiatives have
called on physicians to
reduce waste and
exercise wise
stewardship of
resources.
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ABIM Foundation. Choosing wisely
American College of Physicians. High value
care
AMA Council on Ethical and Judicial Affairs.
Physician stewardship of health care
resources
Joint Commission & AMA. Two leading
health care quality organizations hold
national summit to build consensus around
ways to minimize overuse of five
treatments
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Are We Willing (and Able) to Address the
Problem?
Healthcare Resource Stewardship Council
• Initially organized by BCBSM in 2011 to focus on the access to
and affordability of care for Michigan citizens now and far into
the future
• Purpose:
– To engage in collaborative efforts to ensure judicious use and
active stewardship of health care resources.
• Organizing principles:
– Principles and governance set by PGIP community leaders
– Large scale representation from PGIP POs
– Integrate hospitals, patients, systems, and employer groups in
future
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Healthcare Resource Stewardship Council
• Current status:
– 26 PGIP POs engaged in initial planning sessions
– Vision and core tenets established in 2012 (see next
slide)
– HRSC Core Group and Value Partnerships meet
monthly
– Working with the Michigan Data Collaborative to
establish a data reporting tool for PGIP POs to
determine compliance rates with Choosing Wisely®
guidelines
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HRSC Vision and Core Tenets
Organize care to put patients first while making wise choices about care
and the use of healthcare resources .
CORE TENETS
COMMUNICATION
ACCESS
WHAT DOES SUCCESS LOOK LIKE?
• Movement from individual care
to population management
• All partners in healthcare
delivery are empowered,
engaged and aligned
ADVOCACY
EMPOWERMENT
WHAT WILL WE ACCOMPLISH?
• Culture change
• Philosophy change
• Shift in accountability
• Measurement to support the accountability
• Payment reform to support the work and
accountability
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HRSC and Choosing Wisely®
• In 2012, HRSC identified focus areas from Choosing
Wisely® guidelines
• Selected only guidelines that could be measured in
BCBSM claims
– Of those guidelines, HRSC identified those that:
• Have a high impact on cost
• Are evidence-based
• Are easily amenable to change
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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.
Consumer Reports leads consumer communication efforts for this
campaign.
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What is the Physician’s Role
in Choosing Wisely?
The Charter’s commitment to a just
distribution of finite resources specifically calls
on physicians to be responsible for the
appropriate allocation of resources and to
scrupulously avoid superfluous tests and
procedures.
Choosing Wisely Partners
Societies Released Lists in April 2012
Societies Releasing Lists in Sept 2013
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AMDA – Dedicated to Long Term Care Medicine - 9/4
American College of Surgeons - 9/4
Commission on Cancer – a multidisciplinary program of the
American College of Surgeons - 9/4
American Academy of Orthopedic Surgeons - 9/11
Society of General Internal Medicine - 9/12
American Psychiatric Association - 9/20
American Society for Radiation Oncology - 9/23
American Academy of Family Physicians** - 9/24
American College of Medical Toxicology and the American
Academy of Clinical Toxicology - 9/26
American Academy of Allergy Asthma & Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Nephrology
American Society of Nuclear Cardiology
American Society of Clinical Oncology
Societies Releasing Lists in Feb 2013
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American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology-Head and Neck
Surgery
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
American College of Rheumatology
American Geriatrics Society
American Society for Clinical Pathology
American Society of Echocardiography
American Urological Association
Society of Hospital Medicine
Society of Nuclear Medicine and Molecular Imaging
Society of Thoracic Surgeons
Society of Vascular Medicine
Societies Releasing Lists in Oct 2013
American Association for Pediatric Ophthalmology and
Strabismus - 10/8
North American Spine Society - 10/9
American College of Emergency Physicians - 10/14
American Association of Clinical Endocrinologists/The Endocrine
Society - 10/16
American College of Chest Physicians/American Thoracic
Society (Pulmonary) - 10/27
American College of Rheumatology* - 10/27
American Society of Dermatology - 10/29
American Society of Clinical Oncology* - 10/29
Society of Gynecologic Oncology - 10/31
Choosing Wisely Partners contd.
November 2013
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American Headache Society - 11/21
December 2013
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American Society of Hematology - 12/4
January 2014
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American Association of Critical-Care Nurses/American
College of Chest Physicians/American Thoracic
Society/Society of Critical Care Medicine (Critical Care) - 1/11
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Society for Cardiovascular Magnetic Resonance - 1/16
February 2014
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Society for Maternal-Fetal Medicine - 2/3
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Heart Rhythm Society - 2/10
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American College of Occupational and Environmental
Medicine - 2/24
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The American Geriatrics Society* - 2/27
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American Academy of Allergy, Asthma & Immunology - 2/28
Release Date TBD
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American Association of Blood Banks
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American Association of Neurological Surgeons
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American Society of Anesthesiologists
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American Society of Colon and Rectal Surgeons
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American Society of Plastic Surgeons
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Consumer Groups Through Partnership with
Consumer Reports
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AARP
Alliance Health Networks
Leapfrog Group
Midwest Business Group on Health
Minnesota Health Action Network
National Business Coalition on Health
National Business Group on Health
National Center for Farmworker Health
National Hospice and Palliative Care Organization
National Partnership for Women & Families
Pacific Business Group on Health
SEIU
Union Plus
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Wikipedia
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How the Lists Were Created
• Societies were free to determine the process for
creating their lists
• Each item was within the specialty’s purview and
control
• Procedures should be used frequently and/or carry a
significant cost
• Should be generally-accepted evidence to support
each recommendation
• Process should be thoroughly documented and publicly available upon request
Actions
Dozens of 2-Page Brochures
(in plain English & Spanish)
HRSC Recommendations – Bundled Focus Areas
Imaging of
Uncomplicated
Conditions
• ACR1 - Don't do imaging for uncomplicated headache
• ACP2 - Don't obtain back imaging studies in patients with nonspecific low back pain
• AAAI2 - Don't order sinus computed tomography (CT) or
indiscriminately prescribe antibiotics for uncomplicated acute
rhinosinusitis
Cardiology Tests in
Low-Risk Individuals
• ASNC1 - Don't perform stress cardiac imaging or coronary
angiography in patients without cardiac symptoms unless highrisk markers are present
• AAFP4 - Don't order annual electrocardiograms (EKGs) or any
other cardiac screening for low-risk patients without symptoms
Women’s Health
• AAFP5 - Don't perform Pap smears on women younger than 21 or
who have had a hysterectomy for non-cancer disease
• AAFP3 - Don't use dual-energy x-ray absorptiometry (DEXA)
screening for osteoporosis in women younger than 65 or men
younger than 70 with no risk factors
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HRSC Choosing Wisely Guidelines A3
BACKGROUND
ANALYSIS
• Unsustainable “system” of increased costs
• Unnecessary services (passive provider
involvement and waste/harm)
• Uneducated consumer
• Opportunity for education of providers, patients,
payers and employers
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Lack of knowledge
Time constraints / Workflow disruption
Financial disincentives
Cost to develop and distribute materials
RECOMMENDATIONS
TOOLS (Reports and Decision Aids)
• Handouts
• App
STRATEGIES
• Engagement with community partners (e.g. GDAC)
• Marketing (“jingle” – “We choose wisely together.”
FINANCIAL
• Incent for wiser decisions by providers and patients
CURRENT CONDITIONS
Per Capita Spending
Variations
PLAN
What / Who / When
• Choosing Wisely analysis and dashboard
SMART
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Specific
Measurable
Actionable
Relevant
Achievable
GOALS
FOLLOW-UP
• Increased awareness
• Decreased cost / capita
• Distribution of Tool
• Engagement of stakeholders
Choosing Wisely Reporting Tool
Ellen Bunting
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Finding the
Choosing Wisely® Reporting Tool
1. PGIP Collaboration Site (must be a member of a participating
PO and be registered to gain access)
2. Choose the Analytics Tab
3. Within Analytics choose MPAC
4. Under MPAC Documents, click on Choosing Wisely Reporting
Tool
The tool will be available as of December 6, 2013.
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Choosing Wisely® Workgroup
• Convened by GDAHC and MSMS in June 2013
• Workgroup comprised of various stakeholders
• Goal to create uniform training curriculum for health
care professionals and consumers
• Training aligns with HRSC recommendations:
Cardiology, Imaging and Women’s Health
• Curriculum and lead trainers are ready to test the
tools and learning approach
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Choosing Wisely® through the
Michigan Health Information Alliance
Gary Billotti
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• Choosing Wisely®:
http://www.choosingwisely.org/
• ABIM Foundation:
http://www.abimfoundation.org/
• Consumer Reports Health:
http://consumerhealthchoices.org/campaigns/choosing-wisely/
• Ellen Bunting, Senior Business Analyst, Michigan Data Collaborative
[email protected]
• Sheri Lee, Senior Health Care Analyst, Value Partnerships
[email protected]
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