Chad DillardExecutive Director for Marketing, Communications and Wellness

Kelly SwanCommunication Strategy Manager

Introducing Choosing Wisely®

to a healthcare systemApril 15, 2015

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Pop QuizHave you, a family member or friend everreceived a medication, medical test orprocedure and wondered whether it wasnecessary?

Pop QuizDuring a physician office visit, have you, afamily member or friend ever specificallyrequested from the doctor a drug, like anantibiotic, or a test, like an MRI?

Pop QuizPhysicians: Have you ever had a patientor patient’s family member demand adrug or test?

Pop QuizPhysicians: Have you ever written a drugprescription or ordered a test because thepatient or a family member asked for it,even though you didn’t think it wasneeded?

Setting the stage

Healthcare spending per capita, 2008Adjusted for differences in cost of living

*2007Source: OECD Health Data 2010 (Oct. 2010)

* 2008** 2007Source: OECD Health Data 2011 (June 2011) via The Commonwealth Fund

Hospital spending per discharge, 2009Adjusted for differences in cost of living

Total Expenditure on Health per capita, $US (PPP Adj.)

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“U.S. spends $650 Billion (30%) more than expected onhealthcare without commensurate benefits.”

Healthcare Spending per capita vs. Average Life Expectancy Among OECD Countries, 2007~McKinsey, Global Institute Analysis

Source: www.kpcb.com/ USA Inc., “What Might a Turnaround Expert Consider?” (OECD data), KaufmanHall

Must-do strategies1. Aligning hospitals, physicians and

other providers across the continuum2. Using evidence-based practices to

improve quality and patient safety3. Improving efficiency through

productivity and financialmanagement

4. Developing integrated informationsystems

Goal:First curveto secondcurve

1. Safe: avoiding injuries to patients from care intended to help them.

2. Effective: providing services based on scientific knowledge to all who could benefit, and refraining fromproviding services to those not likely to benefit.

3. Patient-Centered: providing care that is respectful of and responsive to individual patient preferences,needs, and values, and ensuring that patient values guide all clinical decisions.

4. Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.

5. Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.

6. Equitable: providing care that does not vary in quality because of personal characteristics such as gender,ethnicity, geographic location, and socioeconomic status.

6 aims for improvement in care:

Who we are

Anne Arundel Medical Center

Anne Arundell 1615-1649

Overarching goals of Choosing Wisely®:

• Promote wise choices by clinicians and patients in order toimprove health care outcomes

• Provide patient-centered care that avoids unnecessary and evenharmful interventions

Two audiences for Choosing Wisely

Public Messages• More is not always better

– Harm risk– Cost risk

• Have a dialogue-not a test

Medical Staff Messages• More is not always better

– Consider harms– Consider costs

• Follow professional societyrecommendations

Reaching our audiences

Internal

Employee newsletter

Digital displays throughout main campusand doctor offices

Medical staff

CommunityAAMC Magazine: Distribution 200,000

CommunityNews clips: columns, articles

CommunityEvents and Special Programs

CommunityLocal, State and National Media

Lessons learned

Lessons learnedFeedback from the public

The bad news:

• Messages about cost sound a lot like

rationing/ObamaCare.

• Death panels and ageism

• “I don’t want to wait to see if symptom X

resolves; I need to ease my mind now.”

• Perception that more tests = better care

The good news:

• Messages about “harm reduction” are more

powerful.

• People are wary of medical radiation.

• People know about antibiotic overuse (but

want to feel better faster).

• People trust their doctors.

• Lists over-emphasize radiology

• Radiation fear is exaggerated

• I don’t believe in guidelines (fear ofdisrupting physician autonomy)

• This is all about patient demand• You gonna come with me to court? (fear

of liability)

• I believe in being thorough

• My duty is to the patient, I don’t worryabout cost.

• Much more money is wasted by others in:readmissions, surgeries, high hospitalcosts, drug costs…

• Affirmation bias

• Social Norms: “But this is how we do itin my practice/ED/city”

• Gratitude for the effort

Lessons learnedFeedback from the medical staff

• Tweak public outreach strategy to target specific audienceswith most relevant topics (Ex: parents and antibiotics)

• Tweak physician outreach strategy to be more collaborative

• Searching for a way to measure both awareness and impact

• Understanding patient motivations (why do they seek low-value tests)

• Understanding physician motivations (why do they ordertests/procedures they know are low value?)

Next steps

Questions?