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A campaign to help patients and providers make smart choices about care options
Howard Epstein, MD, FHM, CHIE Chief Health Systems Officer, ICSI
1 © ICSI 2013
Affordability Within the Triple Aim: Choosing Wisely® Minnesota
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ICSI: Who We Are
Improve population health
Improve patient experience of care, including quality
Improve affordability by decreasing per capita costs
Targeting the Triple Aim*
*The Triple Aim: Care, Health, And Cost. Berwick DM, Nolan TW and Whittington J., Health Affairs, May 2008, Vol. 27, No. 3, 759-769.
Wedge Model for US Health Care With Theoretical Spending Reduction Targets for 6 Categories of Waste
Source: Eliminating Waste in US Health Care, Berwick, D., Hackbarth, A. JAMA. 2012;307(14):1513-1516
1. Failures of Care Delivery
2. Failures of Care Coordination
3. Overtreatment 4. Administrative
Complexity 5. Pricing Failures 6. Fraud & Abuse
Waste Subcategories
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“A Top 5 list also has the advantage that if we restrict ourselves to the most egregious causes of waste, we can demonstrate to a skeptical public that we are genuinely protecting patients’ interests and not simply ‘rationing’ health care, regardless of the benefit, for cost-cutting purposes.”
– Howard Brody MD, PhD
Medicine's Ethical Responsibility for Health Care Reform - The Top Five List
Brody H. Medicine's ethical responsibility for health care reform -- the Top Five list. N Engl J Med 2010;362:283-285
Underuse Appropriate Use Overuse
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ICSI’s Choosing Wisely Survey
© ICSI 2013
• Baseline assessment of awareness and interest regarding Choosing Wisely
• Randomized survey of over 200 physicians, APNs, PAs, nurses and clinic administrators who have worked on ICSI guideline workgroups or other initiative
• Distributed via email and completed on SurveyMonkey
• July 29 through August 5, 2013
• 39% response rate, over half were physicians
Familiarity with Choosing Wisely:
10 © ICSI 2013
Implementing Choosing Wisely?
11 © ICSI 2013
Unnecessary tests or procedures?
12 © ICSI 2013
Discussion of unnecessary tests
13 © ICSI 2013
Barriers to discussing unnecessary tests or
procedures
14 © ICSI 2013
15 © ICSI 2013
Consumer Reports Patient Materials •Consumer Reports is a partner in Choosing Wisely and will support the effort by creating patient-friendly materials based on the society recommendations and engaging a coalition of consumer communication partners to disseminate content and messages about appropriate use to the communities they serve.
•Consumer tools and resources can be found at: www.consumerhealthchoices.org
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Other ICSI Choosing Wisely Activities
© ICSI 2013
Embed Choosing Wisely® Campaign messaging and specific recommendations into ongoing initiatives:
• ICSI Guidelines – Preventive Services, Palliative Care, Chronic Pain, Diabetes
• Patient Advisory Committee
• Shared Decision Making • Decision Support (example: HTDI)
• Medical Education: U of M Internal Medicine residency
– Value Based Care curriculum
• Challenge “more is better” culture
Thank you
Additional Resources: www.ICSI.org https://www.icsi.org/health_initiatives/health_care_affordability/ (Video courtesy of Twin Cities Public Television (tpt), The Bush Foundation, and ICSI) http://consumerhealthchoices.org/choosing-wisely-minnesota/ Email: [email protected]