Communication key to wise treatment choices

STRATEGY FOR IMPROVING HEALTH: Dr. Matthew Collins, left, vice president for clinical integration at Blue Cross & Blue Shield of Rhode Island, works on Choosing Wisely programming with Smita Wadhwani, manager of case management, and John Davia, lead wellness consultant. / PBN PHOTO/ MICHAEL SALERNO
STRATEGY FOR IMPROVING HEALTH: Dr. Matthew Collins, left, vice president for clinical integration at Blue Cross & Blue Shield of Rhode Island, works on Choosing Wisely programming with Smita Wadhwani, manager of case management, and John Davia, lead wellness consultant. / PBN PHOTO/ MICHAEL SALERNO

Dr. Matthew Collins, vice president for clinical integration at Blue Cross & Blue Shield of Rhode Island, once had a patient who repeatedly went to her local emergency room complaining of headaches or abdominal pain.

Every one of 18 CAT scans provided during some of those visits was negative, Collins recalled.

Had the ER doctors and the patient been exposed to a Choosing Wisely campaign designed to educate people about asking the right questions before ordering medical tests, procedures or medications, those costly tests, which expose the patient to radiation, might have been avoided, Collins said.

“There’s lots of evidence that doctors overprescribe, over-test,” he said. “[The Choosing Wisely program] just gives members another tool to decide and makes them the educated consumers.”

- Advertisement -

Blue Cross is one of eight businesses and organizations participating in the first statewide Choosing Wisely program in the country, led by the Rhode Island Business Group on Health and the Rhode Island Medical Society. A kickoff for the Rhode Island campaign was held earlier this month at Brown University.

The national program, now spreading internationally, was launched in 2012 by the American Board of Internal Medicine Foundation and Consumer Reports. More than 70 medical-specialty societies that support doctors, nurses and specialists participate nationwide.

The campaign provides five questions patients and doctors share and discuss together before agreeing on medical procedures or prescriptions.

The five questions revolve around whether the test, prescription or procedure is really needed; the risks; safer or simpler alternatives; the do-nothing option; and cost.

In addition, there are lists of tests and procedures for patients and doctors that focus on what is appropriate under certain circumstances. The lists are not intended as recommendations but rather as guidelines, the website states.

“The message of Choosing Wisely is all about educating patients for communicating with their physicians, not about prescribing certain types of treatment,” Dominic J. Lorusso, director of Consumer Reports’ Health Partnership said. “The ‘secret sauce’ is that a doctor is saying, ‘You may not need that test or antibiotic.’ It’s a powerful message.”

Lorusso, Rhode Island participants and Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation, emphasize that the aim of Choosing Wisely is to promote better-quality health care. Yet, cost-savings can be a byproduct, they said.

The foundation administers a grant program with support from the Robert Wood Johnson Foundation, and the resulting Choosing Wisely program is free to participants, said Al Charbonneau, executive director of the RIBGH.

The RIBGH signed an agreement with Consumer Reports to launch a campaign in 2014, and this past January received a $50,000 grant from the Rhode Island Foundation to provide a pilot on opioid use that is aimed at deterring abuse of pain medications.

Joanne Bilotta, the lead member of the board of directors for RIBGH’s campaign, said the work to raise grant funding has taken time, but that the five questions used by doctors and patients to prevent unnecessary medical procedures and waste has the potential to change the way health care is delivered.

“We felt the concept … is a great way to help bring that message of affordability and cutting out waste,” Bilotta said.

Brown and Amica Mutual Insurance Co., a property and automotive insurer, were early adopters of the program. Besides Blue Cross, newer participants now include Providence, UnitedHealthcare of New England and the Tufts Health Plan.

The R.I. Medical Society and Rhode Island Quality Institute, which will help with designing ways to track progress, are also participants, Charbonneau said.

Brown, which has about 4,000 benefits-eligible employees, and Lincoln-based Amica, with about 1,500 Rhode Island employees, are eager to see their workers get the right care at the right time by participating in the program, representatives said.

In addition to employees, retirees, dependents and spouses will be able to use the Choosing Wisely program, said Drew Murphy, Brown’s director of benefits, and Scott Boyd, Amica’s senior assistant vice president and director of compensation and benefits.

Prior to the statewide rollout, Brown’s Choosing Wisely micro-website only had about 300 hits, but Murphy expects the program to grow.

“It’s one thing to have consumers involved, but it’s also very important to have the providers engaged,” said Boyd. “They need to be willing to have this material in their offices. It can’t be a one-way street.” •

No posts to display