On Thursday, April 12, pioneers of healthcare reinvestment convened as part of the Health Activist Network to discuss the Choosing Wisely® initiative and how leaders can rethink about value in their own organizations. Daniel Wolfson, COO of ABIM Foundation and champion of Choosing Wisely®, was joined by local leaders Mark DeRubeis, CEO and Frank Colangelo, MD, Chief Quality Officer of Premier Medical Associates, along with transformational leader, Vivian Lee, MD, former Dean, SVP and CEO of University of Utah Health, to provide insights into this mission of reinvestment.
Daniel provided an in-depth overview of how Choosing Wisely® was started in 2012, including obstacles and successes and its timely development alongside of the Affordable Care Act. Choosing Wisely® aims to address the estimated $750 billion spent in the U.S. each year on services that don’t actually improve health outcomes. Of that $750 billion, more than a quarter is used on unnecessary, or non-value-added, care — care that doesn’t improve health outcomes and can actually lead to patient harm. To address this, Choosing Wisely® has developed into an open platform tool that is built upon three primary principles: 1. It is physician and patient led; 2. The initiative is driven by evidence; and 3. Relationships must be trusted between many parties so that we can have collaboration between multiple stakeholders. Guided by these principles, healthcare practices can utilize the Choosing Wisely® toolkit to fit their needs and drive a more value-based system.
Ultimately, if you’re driven by volume, Choosing Wisely® is going to be less relevant to your delivery system. Choosing Wisely® requires a change of mindset. A movement from, ‘why did you do that test?’ to ‘what was the need for that test?’ When the thinking focuses upon what gives value in health care, the process changes. But the burden isn’t simply upon the physician for this campaign, as Choosing Wisely® also developed materials for patients, to help educate and empower them to change the conversation with their physicians.
Here in Pittsburgh, Premier Medical Associates, led by Chief Quality Officer, Dr. Frank Colangelo and CEO Mark DeRubeis, have totally transformed their work with a value-based approach to their care. Early on in their development they choose to take the path of quality and completely changed their infrastructure to match. Then when they heard about Choosing Wisely®, they began to adopt its standards. “Choosing Wisely® brought the most immediate instant gratification that you could ever ask for,” said Mark DeRubeis. “This is not plug and play. You have to have a culture around quality improvement.”
Out west in Utah, Dr. Vivian Lee helped develop more value-based transformation at Utah’s largest health system, University of Utah Health (UUH), during her time as Dean, SVP and CEO. In order to really identify the value data, UUH launched a value-drive outcomes tool that enhanced the standard CMS process measures. Teams of doctors helped define evidence-based quality measures and they were combined with patient satisfaction and reported outcomes to create a substantial tool for measuring value. “You can’t manage what you can’t measure,” stated Dr. Lee.
Not every organization is ready to adopt a tool like Choosing Wisely®, but Daniel Wolfson outlined the three ingredients that are needed for it to take hold. First is a commitment to go move away from volume, second is an infrastructure around quality improvement and safety, and last is good community partnerships.