Choosing Wisely and Healthcare Resource Stewardship Council (HRSC)

1. Choosing Wisely and Healthcare Resource Stewardship Council (HRSC) PGIP Meeting December 6, 2013

2. Why stewardship? Why now? • Health care expenditures are increasing at unsustainable rates • 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% • 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 • 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

3. Excess Cost Domain Estimates IOM. The Healthcare Imperative, 2010.

6. 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. • 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. 

7. Are We Willing (and Able) to Address the Problem?

8. 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

9. 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

10. 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 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 • WHAT DOES SUCCESS LOOK LIKE? • Movement from individual care to population management • All partners in healthcare delivery are empowered, engaged and aligned

11. 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

12. 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. Choosing Wisely 13

13. 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.

14. Choosing Wisely Partners Societies Released Lists in April 2012 • 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 Sept 2013 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 Societies Releasing Lists in Feb 2013 • 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

15. Choosing Wisely Partners contd. • Consumer Groups Through Partnership with Consumer Reports • 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 • Wikipedia November 2013 • American Headache Society - 11/21December 2013 • American Society of Hematology - 12/4 January 2014 • American Association of Critical-Care Nurses/American College of Chest Physicians/American Thoracic Society/Society of Critical Care Medicine (Critical Care) - 1/11 • Society for Cardiovascular Magnetic Resonance - 1/16 February 2014 • Society for Maternal-Fetal Medicine - 2/3 • Heart Rhythm Society - 2/10 • American College of Occupational and Environmental Medicine - 2/24 • The American Geriatrics Society* - 2/27 • American Academy of Allergy, Asthma & Immunology - 2/28 Release Date TBD • American Association of Blood Banks • American Association of Neurological Surgeons • American Society of Anesthesiologists • American Society of Colon and Rectal Surgeons • American Society of Plastic Surgeons

16. 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

17. Actions

18. Dozens of 2-Page Brochures(in plain English & Spanish)

19. HRSC Recommendations – Bundled Focus Areas

20. HRSC Choosing Wisely Guidelines A3

21. Choosing Wisely Reporting Tool Ellen Bunting

22. Finding the Choosing Wisely® Reporting Tool • PGIP Collaboration Site (must be a member of a participating PO and be registered to gain access) • Choose the Analytics Tab • Within Analytics choose MPAC • Under MPAC Documents, click on Choosing Wisely Reporting Tool The tool will be available as of December 6, 2013.

23. 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

24. Choosing Wisely®through the Michigan Health Information Alliance Gary Billotti

27. 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 ebunting@med.umich.edu • Sheri Lee, Senior Health Care Analyst, Value Partnerships slee2@bcbsm.com