Transformation Rx Vlog: Appropriate Use of Care – Engaging Patients and Care Teams Using the Choosing Wisely Approach

The Transformation Rx Vlog provides a variety of perspectives on efforts to improve the quality and affordability of healthcare. 

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Appropriate Use of Care: Engaging Patients and Care Teams Using the Choosing Wisely Approach

With Dr. Erik Steele, DO, Martin’s Point Health Care, Maine

Dr. Erik Steele, DO, sees the Choosing Wisely Campaign as a “tremendously” valuable tool at a time when families, employers, and providers need easily-accessible information and recommendations about appropriate care. Dr. Steele doesn’t just tout Choosing Wisely – he uses it. Since 2012, he has applied the tools and approaches recommended by the program as a patient, in his family practice, as a practice administrator, as a former executive of a health system that employs 9,000 and spends $65-million a year on employee health needs, and as the former Executive Director of Maine Quality Counts, a regional health improvement collaborative (RHIC).

How can providers best use the Choosing Wisely model to engage patients in their own care?

Dr. Steele says providers need to consider cost concerns as well as health concerns in every interaction with patients because: 1) More patients have higher out-of-pocket expense these days. “Whether you bring it up yourself or nobody brings it up in the exam room, cost is part of the decision making. So put it on the table.” 2) The mounting evidence of wasteful care in the system. “Wasteful care here means the patient doesn’t have money to spend over there. Or an employer doesn’t have money to help keep employees’ share of premiums as low as possible. So no matter where we waste care now, it has repercussions that we as providers need to be responsible for.”

The recommendations offered through Choosing Wisely have been developed and agreed upon by both professional provider organizations and consumer groups. They have been tested through medical studies and are evidence-based. The Choosing Wisely website is very user-friendly and Dr. Steele often looks at it with patients while they are together in the exam room. “They can see why certain tests or treatments are or are not recommended in cases like theirs – that it’s not just me saying this. It’s my professional colleagues and their fellow patients who are offering this advice as a result of stringent testing and widespread experience.”

How can patients utilize Choosing Wisely to engage providers?

Patients are often hesitant to ask questions of their provider that might come across as confrontational, or they are overwhelmed by health and cost concerns and don’t know what questions to ask. Choosing Wisely offers straightforward guidance on this. Dr. Steele says at the very least, patients should ask one simple but powerful question: “Is there anything I can do to avoid needing to have this test or treatment.” He says it opens the door to the deeper conversation and it gives the provider confidence or permission to suggest alternatives. “Oftentimes, providers recommend a test or treatment because they think that’s what you want or they are afraid of being sued if they don’t.”

What health conditions in particular has Choosing Wisely identified for high potential of overuse?

A few examples are persistent headaches, lower back pain and antibiotics for children. Choosing Wisely offers concrete recommendations on options for treatment and how to avoid unnecessary services. “It really helps us all feel better about NOT having a test in many cases when it’s really unnecessary.”  The campaign offers a variety of tools, including, “Five Things Physicians and Patients Should Consider.

How can Choosing Wisely help guide team-based care that involves all stakeholders – including employers and health plans?

In the same way physicians can work with Choosing Wisely tools, so can employers. Companies can encourage employees to look at the Choosing Wisely website BEFORE they visit the doctor to gain information that may help them avoid a visit altogether, or help them develop the right questions so they can play a greater role in the decision-making process.

Care teams can systematically use Choosing Wisely guidelines and recommendations to coordinate care, and should inform their patients that they are doing so to ensure everyone is on the same page.

Insurers can likewise engage in discussions with employers and consumes around Choosing Wisely recommendations. “It’s a tremendous tool to build consensus and therefore avoid tests, treatments and expenses that are unnecessary.”

How do Choosing Wisely approaches help patients, providers, health systems, health plans, and employers realize significant savings?

Studies by the federal government and medical associations consistently show that up to a third of all health-related expenditures in the United States are for services that are of marginal or little value.

By utilizing Choosing Wisely approaches, Dr. Steele believes all stakeholders can start to work toward saving that money. “For a typical family spending about $10,000 annually on healthcare, with a $5,000 deductible, that’s enough savings to take everyone to Disney World. If you are a business with 50 employees, that’s thousands and thousands of dollars saved every year. On a national scale, that’s enough savings to pay for every single uninsured American.”


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