A campaign to help patients and providers make smart choices about care options

Howard Epstein, MD, FHM, CHIE Chief Health Systems Officer, ICSI

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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:

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Implementing Choosing Wisely?

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Unnecessary tests or procedures?

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Discussion of unnecessary tests

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Barriers to discussing unnecessary tests or

procedures

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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: hepstein@icsi.org