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'Choose Wisely' to Shrink Healthcare Costs

 |  By John Commins  
   March 27, 2013

The healthcare sector should be given a pat on the back for innovative work over the past few years that has "bent the cost curve" to a point where healthcare inflation is riding a few percentage points higher than overall inflation.

That may seem like faint praise. The 4% annual increase in healthcare spending in 2011, as reported by the Congressional Budget Office in February, grew faster than most paychecks. Still, it's about half of the rate seen in the early 2000s, according to a recent analysis by Moody's Investors Service.

Analysts have acknowledged that much, but not all, of that slower cost growth can be attributed to the effects of a dragging economy marked by higher unemployment, the loss of health insurance coverage, and the advent of high-deductible health insurance plans. Better management plays a role too, as providers scan the healthcare cost spectrum from patient throughput to floor wax for savings through new efficiencies and waste-cutting measures.

All of this in-house reordering by providers is only half the battle. As has been noted, if we want to reduce healthcare expenditures we have to change the behaviors, expectations, and decisions made by healthcare consumers, a.k.a. patients.

This will be considerably harder to do than carving out new throughput efficiencies or entering a group purchasing organization. That's because providers will be battling decades of conditioned behaviors by healthcare consumers, who are taught to believe that their health problems can be solved with the right pill or the next new test or a "routine" operation.


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A primary care physician during a wellness exam may have 20 or 30 minutes once a year or so to talk with a patient about eating right, losing weight, quitting smoking and exercising more. The moment that patient leaves the physician's office he is bombarded by advertising and messaging that urges him to do exactly the opposite.

When these consumers begin to suffer the effects of that overindulgence, be it acid reflux or high blood pressure or lower back or knee pain, they're assured that relief is close at hand with the right mix of pharmaceuticals, cutting-edge cancer therapy, or the latest orthopedic procedure. They're urged to "consult with your doctor." That is subtle way of telling healthcare consumers to pressure their docs into prescribing a material solution that someone is selling instead of addressing the underlying behaviors that are causing the problem.

This dynamic has to change. And the best way to change it is to educate and involve patients in their own care. This can transform them from healthcare consumers demanding the next great cure into discerning advocates for their own health.

Again, this will not be easy because the countervailing winds in our consumer culture celebrate uncritical overindulgence and easy remedies.

This week, the American Board of Internal Medicine Foundation announced that it would grant about $70,000 in funding to each of 21 state medical societies, specialty societies, and regional health collaborative as part of its year-old  Choosing Wisely campaign. The campaign wants to create a dialog between physicians and patients about medical tests and procedures that have been identified by medical specialty societies as either unnecessary, wasteful, or even harmful in some cases.

"What it will do is change the conversation by using shared decision-making between the patient and the provider," says Cally Vinz, vice president of Minnesota's Institute for Clinical Systems Improvement, which wants to expand the Choosing Wisely campaign across the Land of 10,000 Lakes.

"We also hope to change the perspective of the consumer as they come in by educating them about what they shouldn't be asking for or shouldn't be expecting if it is not high value," Vinz explains.

"Then the provider is comfortable with having a conversation and the health plan isn't covering it in the same way because it is an unnecessary exempt. This goes across the whole continuum from the consumer's expectation to the provider's system that supports him to do the right thing to have the conversation and the healthcare coverage supporting the right kind of testing."

The ABIM Foundation was smart to enlist the support and advice of medical specialty societies. It is heartening to see that these professional medical organizations are dedicated to quality care and want to ensure the right treatment at the right time, even if it means reducing the number of MRIs for lower back pain or fewer antibiotics prescribed for sinusitis.

In the next two months, Vinz says, the Choosing Wisely campaign with the help of the medical societies will identify and focus on five medical tests or interventions that are not value-driven or are not recommended in most cases.

"We will be focusing on those initially and identifying how we can educate employers, consumers, and care providers that these are unnecessary," she says. "As we do that and talk to consumers and employers about these things we will learn lessons about how to take on another five or 10 or 20 tests or interventions because there are hundreds of them."

Vinz acknowledges that the Choose Wisely movement will have a hard time changing the ingrained expectations of healthcare consumers but she is also optimistic.

"Patients want what they want when they want it but they don't want unnecessary care," she says. "They don't want things that put them at risk because sometimes these tests can cause harm or send you down a path that isn't helpful. We have to help to educate them about being a partner in their health, working with their providers and employers in shared decision making."

Vinz believes that Choosing Wisely will "get the conversation started."

"It has to start somewhere," she says. "United States citizens have to start to learn that more isn't always better and expecting more isn't always going to be helpful and safe for you."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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