1. Choosing Wisely® An Initiative of the ABIM Foundation Cassie Dictus Judy Richardson, MD

2. Outline Overview of campaign – Impetus and materials available The OMA’s focus and available support – Conversations and the “5 Questions” Current and future actions and implementations Pacific Source Clinical Advisory Panel’s story

3. Note Please feel free to type questions & comments as we go. We will pause for discussion/Q and A throughout.

4. Choosing Wisely 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. http://www.choosingwisely.org/wp-content/uploads/2013/09/Choosing- Wisely-One-Pager.pdf

5. Choosing Wisely “The wise start with the whys.”

6. Background Berwick DM, Hackbarth AD. Eliminating Waste in US Health Care. JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362. Overtreatment = $158 - $226 billion in 2011

7. Patient Safety Three types of risks for screenings: 1. Procedure itself (radiation) 2. Imprecision (false-positives & negatives) 3. Treatment of non-clinically significant conditions (overdiagnosis) http://www.cancer.net/navigating-cancer-care/prevention-and-healthy- living/cancer-screening

8. Physician Charter A Commitment to Professional competence Honesty with patients Patient confidentiality Maintaining appropriate relations with patients Improving quality of care Improving access to care A just distribution of finite resources Scientific knowledge Maintaining trust by managing conflicts of interest Professional responsibilities Fundamental Principles Primacy of patient welfare Patient autonomy Social justice http://www.abimfoundation.org/Professionalism/Physician-Charter.aspx

9. Barriers

10. Why Are Overuse and Misuse So Important? Potential for patient harm Public health implications Missed opportunity for more effective care Waste of precious resources -Our patients time -Our time -Cost

11. Thoughts? How do the ideas of waste, value and patient safety resonate? - Personally? - With your CCO’s focus? Do you feel comfortable talking about these issues?

12. Sparking Conversations Lists of “Top 5 Things Physicians and Patients Should Question”: – Evidences indicates unnecessary – Frequent and/or costly ($ or harm) – Not usually controversial (“Top 5 top $5 Billion”) Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” Lists Top $5 Billion. Arch Intern Med. 2011;171(20):1858-1859. doi:10.1001/archinternmed.2011.501.

13. Top 5 Lists http://cepac.icer-review.org/wp-content/uploads/2014/03/Prioritizing-Opportunities-for- Reducing-Inappropriate-Care-in-New-England_ACOG.pdf

14. Evidence

15. Sparking Conversations Consumer Reports created corresponding patient-centered materials: – 60 Pamphlet Topics (Plain English & Spanish) – Posters, Wallet-card – Videos, PSA

16. Patient Pamphlet

18. The gift that keeps… 9 societies in 2012 --> 60+ societies today SEARCH FUNCTION www.choosingwisely.org http://www.aafp.org/journals/afp/authors/ebm- toolkit/resources/choosing-wisely.html

22. But, “Choosing Wisely” is a game-changer. The advice comes not from payers or politicos, but from pedigreed physician groups. The specialty societies are not guessing; their lists of procedures contain copious scientific citations supporting the claims of overuse.

23. Thoughts? What do you think about the materials so far?

24. OMA Campaign Two-year grant: – Awareness and education – Toolkits tailored by audience – Task force --> Focus on conversations www.consumerhealthchoices.org/OMA

25. Conversation Tool

26. OMA Campaign

27. Patient Wallet Card

28. We can help with… Customization Printing Training and education Best practices Connection to larger CW network Technical assistance

29. http://www.choosingwisely.org/resources/modules/

30. Communication Tips 1. Elicit concerns 2. Empathize 3. Recommend 4. Provide written information 5. Establish a plan

33. Thoughts? Do you think this would be a helpful patient-engagement and shared-decision making tool?

34. Actions Review the recommendations Start a conversation Promotion Use materials http://blog.abimfoundation.org/ Quality improvement projects Employee programs Education integration EHR integration

35. Website Button

36. KUMP-TV & PSA Help Promote: - Website button - Blogs, newsletters, social media, videos, magazine articles - Presentations

37. Social Media I've asked what happens when I don't do anything. So far my doctors have been great. GO BEAV's!!!

38. Communication Tips

39. Social Media Commonly used medical tests and procedures are not always needed. In fact, sometimes more care can be harmful. Talking with your doctor is the best way to make sure you are choosing your care wisely. Have you used these questions with your doctor? Can you think of a time that one or more of these questions might have been useful? Please share your story below.

40. Social Media “I have not used these questions during a doctor visit. But I will sure do that in the future to help gage whether I'm getting the best care for myself. Thanks!”

41. Social Media “I've asked what happens when I don't do anything. So far my doctors have been great. GO BEAV's!!!”

42. Oregon’s CCOs HB 2859 – Task Force on Individual Responsibility and Health Engagement Recommendations: Value-Based Benefit Design Shared Decision-Making Tools http://www.oregon.gov/OHA/OHPR/Pages/irhe.aspx

43. Clinical Advisory Panel’s Role CAP: a 17 member panel composed of physicians from a variety of fields, physical therapists, pharmacists, nurse practitioners Charter: -To review guidelines & prescribing practices -To help providers in our CCO provide better care -Review quality incentive measure performance & provide feedback to providers -Review some transformation project proposals -Think about ways in which we can reduce waste

44. Clinical Advisory Panel’s Role The OMA and Choosing Wisely have given us better tools to talk with patients, encouraging us to use the five questions and help our patients be more informed: -Find out where the patient is coming from – what are they expecting? Is that reasonable? -Explain your reasons. -Make it clear that we are on the same side! -Make the plan clear, review red-flag signs and symptoms

45. Clinical Advisory Panel’s Role CAP: a 17 member panel composed of physicians from a variety of fields, physical therapists, pharmacists, nurse practitioners Charter: -To review guidelines & prescribing practices -To help providers in our CCO provide better care -Review quality incentive measure performance & provide feedback to providers -Review some transformation project proposals -Think about ways in which we can reduce waste

46. Thoughts? Best way to disseminate to your: - CCO? - CAC? - CAP? - Members? - Providers?

47. Contact Information Website: www.consumerhealthchoices.org/omawww.consumerhealthchoices.org/oma Facebook: Oregon Medical Association Twitter: @ORMedicine Cassie Dictus, Program Coordinator cassandra@theOMA.orgcassandra@theOMA.org, 503.619.8000