1. An Invitation to Kanawha County Medical, Nursing, and Health Care Organizations and Providers

2. Choosing Wisely A Physician Led Reform Begun by the National Physicians Alliance Three physician organizations each submitted 5 procedures in their area of expertise that are felt to be of questionable value 2

3. Choosing Wisely – 2014 American Board of Internal Medicine Foundation 60 physician specialty groups and health care organizations involved 250 low-value procedures have been identified 3

4. System Improvements: Why It’s Needed  30% of care is for unnecessary tests, procedures, medical appointments, hospital stays that may not improve people’s health $102 billion in failure of delivery of care (e.g., lack of widespread adoption of best care practices) $158 billion in overtreatment (e.g., overuse of antibiotics) 4 Source: Berwick & Hackbarth, JAMA, 2012;307(14):1515-1516 & Congressional Budget Office

5. System Improvements: Why It’s Needed “The current (payment) system, based on volume and intensity, does not disincentivize, but rather pays more for overuse and fragmentation.” Mark McClellan 5

6. Choosing Wisely Examples of selected procedures include: ◦ Using antibiotics for a viral infection is ineffective and potentially harmful ◦ Don’t order imaging for uncomplicated low-back pain ◦ Use Pap test appropriately ◦ Imaging for headaches is ineffective 6

7. Consumer Reports Five Questions to Ask Your Physician Do I really need this procedure? What are the risks? Are there simpler, safer options? What happens if I don’t do anything? How much does it cost? 7

8. Choosing Wisely Consumer Reports has written 31 two-page summaries for consumers on these low-value services plus other helpful discussion guides for consumers 8

9. Antibiotic Use 9

10. Antibiotics for Pink Eye 10

11. Imaging tests for lower-back pain 11

12. Delivering your baby 12

13. Major National Partners Include: Consumer Report AARP National Business Group on Health Puget Sound Health Alliance National Hospice and Palliative Care Organization 13

14. Challenges Reaching the subset of 1.8 million West Virginia consumers who may use low-value services is difficult. Messaging that more health care is not necessarily better health care is counter-intuitive. 14

15. Choosing Wisely in Kanawha County WE INVITE YOU to take a leadership role ◦ We are seeking medical, nursing and health care organizations as Partners. ◦ We are seeking Participating Providers ◦ We hope to gain insights to help further a statewide - Choosing Wisely in West Virginia initiative 15

16. Choosing Wisely In Kanawha County Choosing Wisely in Kanawha County, a program of (WVAHC), has partnered with Consumer Reports for the Choosing Wisely initiative Our first goal is to engage Provider Organizations as Partners. Our second goal is engage 100 Kanawha County physicians - clinicians as Participating Providers. 16

17. Funding from Greater Kanawha Valley Foundation 12 month initiative Encourage physicians and clinicians to take a leadership role. 17

18. Partner Organizations Will Receive Choosing Wisely materials useful for engaging conversations Encourage membership to be engaged in Choosing Wisely Be listed as a Partner Organization of Choosing Wisely in Kanawha County on materials, website, news releases, media Receive and post 3 prepared articles on Choosing Wisely Members of partner organizations may asked to serve as a spokesperson 18

19. Participating Providers Will Receive materials useful for engaging consumers in conversations about low value medical treatments Be recognized as a Participating Providers in our materials, web site, media May be asked to serve as a spokesperson about Choosing Wisely Receive and complete a short online survey about their experience 19

20. Your Participation Is extremely important to this initiative In fact, your participation is essential Can help us identify the best methods to be used for a future WV state-wide initiative 20

21. Partner Organizations as of September 5, 2014 WV Primary Care Association Kanawha-Charleston Health Department WV Nurses Association WV Perinatal Partnership 21

22. Nancy Tolliver tolliver21@frontier.com Renate Pore renatepore@gmail.com Perry Bryant perrybryant@suddenlink.net Dan Foster Daniel.foster@camc.org 22