Choosing Wisely

1. Choosing Wisely in Washington state

2. Choosing Wisely An initiative of the ABIM Foundation

3. Why Stewardship? Why Now? Health care expenditures are increasing at unsustainable rates • Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011 Approximately 30% of healthcare costs (>$750 billion annually) are on wasted care. • American College of Physicians One third of all physicians acquiesce to patient requests for tests and procedures—even when they know they are not necessary • 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 • Crosson FJ. Change the microenvironment. Modern Healthcare and The Commonwealth Fund [Internet]. 2009; Apr 27

4. “Five Things” Lists ABIM partnered with medical specialty societies to develop evidence-based recommendations of the “Five Things Physicians and Patients Should Question” because they’re ineffective, unnecessary, or harmful. 60+ 300+Participating Tests and specialty procedures societies identified

5. “Five Things” Lists

6. Consumer Reports Health

7. Choosing Wisely in Washington state

8. ABIM Grantees ABIM Foundation awarded funding—through Robert Wood Johnson Foundation—to 9 Regional Collaborative and 12 State Medical Societies/Associations • In Washington: Washington State Medical Association and Washington Health Alliance • Goal: To educate participating physicians about the recommendations from the specialty societies • RWJF also provided additional funding for Consumer Reports to educate consumers/patients

9. Washington Activities Websites • WSMA: Know Your Choices – Ask Your Doctor • Alliance: Own Your Health Communications • WSMA: targeted provider e-mails, articles, action manual, speakers bureau, earned media • Alliance: state-wide data, articles, materials for employer groups, Consumer Engagement Committee • WSMA & WSHA: Medical Officer Collaborative communications Kick-off event for providers in October 2013 Washington State Choosing Wisely Task Force • Co-sponsored by WSMA, Washington Health Alliance and WSHA

10. Washington State Choosing Wisely Task Force’s Goals Working together to advance Choosing Wisely in Washington state: • Identify opportunities for improvement • Accelerate implementation and integration • Reduce the number of unnecessary tests and procedures

11. Washington State Choosing Wisely Task Force Members Inna Andrews, MD Hospitalist Multicare Health System Gary Knox, MD Medical Director Rockwood Clinic Katherine A. Choi-Chinn, MD Board Member WA State Radiology Society Richard Clarfeld, MD Medical Director Overlake Medical Clinics Milton Curtis, MD Medical Director EvergreenHealth Christopher Dale, MD, MPH Medical Director Swedish Medical Center Connie Davis, MD Chief Medical Officer Skagit Regional Health David C. Dugdale, MD Medical Director UW Medicine Scott Foster, MD, MPH Medical Director, Specialists PeaceHealth Medical Group Matt Handley, MD Medical Director Group Health Cooperative Dale Hoekema, MD Chief Medical Officer Kadlec Health System Kent Hu, MD, MPH Associate Medical Director The Everett Clinic Norris Kamo, MD, MPP Associate Physician Virginia Mason Medical Center Dan Kent, MD Medical Director Premera Blue Cross Scott Kronlund, MD Chief Medical Officer Northwest Physicians Network Pat Kulpa, MD, MBA Medical Director Regence Blue Shield Francis Mercado, MD Chief Medical Officer Franciscan Health System Scott Ramsey, MD, PhD Public Health Sciences Division Fred Hutchinson John Robinson, MD, SM Chief Medical Officer First Choice Health Richard Spiegel, MD President and CEO Signal Health Thomas K. Varghese Jr, MD, MS Medical Director UW Medicine Terri Wolber, ARNP, DNP Quality Committee Member Pacific Medical Centers

12. Less waste. Less harm. Choosing Wisely in Washington state Data Report • Used data from Alliance's multi-payer data base representing 3.3 million commercial and Medicaid enrollees • Recognize the value and limitations of claims data • Reported county-by-county Measures • Headache: Imaging for headache • Sinusitis: CT scan for sinusitis • Sinusitis: AB treatment • Back Pain: Imaging for back pain • Syncope: Imaging for simple syncope • Adnexal Cysts: US follow up • Appendicitis: US before CT • Papsunder 21 years • Papswith hysterectomy • Annual Pap tests • Spirometry (underuse measure)

13. Less waste. Less harm. Choosing Wisely in Washington state Key Findings • Variation exists. Often the rates between the lowest and highest performing counties vary by more than twofold. • Overuse is a common problem. • Where you live may influence the treatment you get. • Opportunities to reduce waste exist in every county. • Patients may be getting unnecessary care that costs money and puts them at risk. • Regional patterns may be affected by the availability of services and equipment or provider practice patterns.

14. Less waste. Less harm. Choosing Wisely in Washington state Biggest opportunities for improvement • Imaging for uncomplicated headaches: 25% • Antibiotics for sinus infections: 37% Success Stories • CT scans for sinus infections: <1% • Pap tests for young women under 21 years: 4%

15. Less waste. Less harm. Choosing Wisely in Washington state American College of Radiology’s Choosing Wisely recommendation: “Don’t do imaging for uncomplicated headache”

16. Less waste. Less harm. Choosing Wisely in Washington state American College of Radiology’s Choosing Wisely recommendation: “Don’t do imaging for uncomplicated headache” Commercial average: 22% Medicaid average: 30%

17. “Change One Thing” Initiative By focusing on a single recommendation, we will: • create measurable change • gain valuable information about how to integrate Choosing Wisely recommendations into practice “Don’t do imaging for uncomplicated headache” • impacts a broad range of specialties, provider-types, and care-settings • impacts a large number of patients in our community

18. Choosing Wisely Action Manual Kotter’s 8-Step Process for Leading Change to Integrate Choosing Wisely 1. Establish a sense of urgency 2. Create a guiding coalition 3. Develop a change vision 4. Communicate the vision for buy-in 5. Empower a broad-based coalition 6. Generate short-term wins 7. Never let up 8. Incorporate changes into the culture www.wsma.org/Choosing-Wisely

19. Resources Washington State Choosing Wisely Task Force Reports: Choosing Wisely Action Manual: www.wsma.org/Choosing-Wisely Less Waste. Less Harm: Choosing Wisely in Washington State: wahealthalliance.org/alliance-reports-websites/choosing-wisely Choosing Wisely Claims-Based Technical Specifications: wahealthalliance.org/alliance-reports-websites/choosing-wisely National Choosing Wisely Resources: ABIM Foundation’s Choosing Wisely website: www.choosingwisely.org Consumer Reports Health’s patient education: www.consumerhealthchoices.org/campaigns/choosing-wisely

20. Contact Us WSMA: Jessica Martinson, jessica@wsma.org Alliance: Teresa Litton, tlitton@wahealthalliance.org WSHA: Tanya Carroccio, tanyaC@wsha.org Task Force Chair: Matt Handley, MD, handley.m@ghc.org