In 2012 the ABIM Foundation launched the Choosing Wisely campaign with the goal of kick-starting an important and needed national conversation about unnecessary health care tests and procedures. A pervasive and persistent problem in our health care system, unnecessary care was estimated by the Institute of Medicine to amount to $750 billion a year—roughly 30 percent of health care spending—and was projected to keep growing.
Since then, Choosing Wisely has grown precipitously, adding more than 100 new partners and evolving its approach to make a lasting impact. Most recently, through the support of grants from the Robert Wood Johnson Foundation (RWJF), the campaign has turned from creating awareness of overuse to supporting and measuring the implementation of solutions to the overuse problem.
Planting the Seeds of Change
Building off of its mission to advance medical professionalism, with the Choosing Wisely campaign, the ABIM Foundation took an elegant and surprisingly unprecedented approach, inviting physicians themselves to take the lead in recommending solutions. This was done through national medical specialty societies that developed lists of “Five Things Physicians and Patients Should Question,” which offer specific, evidence-based recommendations that physicians and patients should discuss to help patients make wise decisions about the right care for their individual situations.
The idea was that by having the recommendations come from physicians themselves, they would be trusted by the medical community, and these important conversations would finally start to take place at the point of care delivery. Consumer Reports, a key partner, worked with many of the specialty societies to create patient-friendly translations of their recommendations to ensure patients and physicians could make informed decisions about their care.
Launched with an initial cohort of nine medical specialty societies, in less than a year, a total of twenty-five medical specialty societies with a collective membership of more than 725,000 physicians had joined Choosing Wisely, and they released lists covering 130 recommendations. Today, more than seventy medical specialty societies have joined the campaign, and it has begun to spread internationally to Canada, the Netherlands, Australia, the United Kingdom, and beyond. The success meant that a consistent, thoughtful discussion that surpassed our wildest expectations was taking place within the medical community, and among patients and physicians, about unnecessary care.
From Awareness to Implementation
Following Choosing Wisely’s early success, the ABIM Foundation and the RWJF began to discuss ways in which to maximize the impact of the campaign and drive measurable changes in the U.S. health care system.
The RWJF had long been aware of the costs of overuse and unnecessary care that was being delivered in the U.S. health care system—both in terms of individual health and dollars. The RWJF believes that it is critical that the United States find solutions to these issues to foster a Culture of Health that enables all Americans to live longer, healthier lives.
In recent years the RWJF has supported initiatives at the community level through programs such as its flagship Aligning Forces for Quality initiative. In these the foundation saw the potential for meaningful, lasting health care transformation. The reasoning was that health care is delivered locally, and therefore real change must take place at the local level.
That led the RWJF to provide grants to the ABIM Foundation to spread the trusted content and resources developed by Choosing Wisely into local communities across the country. The result? As of now, the RWJF has funded two cohorts of community-level Choosing Wisely grantees, including an initial set of twenty-one grantees led by state medical societies, specialty societies, and regional health collaboratives. From 2013–2015 they worked to help educate and provide resources to physicians and patients about the recommendations and how to have such conversations.
Supporting Local Synergy and Alignment
Building on the local strategy, in June 2015 the ABIM Foundation and the RWJF announced the selection of seven multistakeholder alliances that will focus on the local implementation of Choosing Wisely at health systems, hospitals, and medical groups (in their regions) that are participating in the grant program. What is most exciting to us is that each of the grantees will be focusing on achieving measurable reductions of at least three Choosing Wisely recommendations, including reducing the use of antibiotics for viral infections by at least 20 percent over nearly three years. This work aligns with recent efforts announced by the Obama administration to combat antibiotic resistance.
The most recent phase of Choosing Wisely represents an exciting and potentially powerful development in the campaign. It brings together a potent triad of organizations to work together at every level of the local health care systems, including physicians (through state medical or specialty societies); consumers (through regional health collaborative or multistakeholder groups); and health care delivery systems (through health systems, hospitals, and medical groups).
For example, a new grantee, the University of California, Los Angeles (UCLA) Department of Medicine, is leading a strong coalition of six partners including the Los Angeles County Department of Health Services, the Los Angeles County Department of Public Health, the Los Angeles County Department of Health Services Primary Care Practice-Based Research Network, the Wellness Center at Historic General Hospital, and the Society of General Internal Medicine. Through their Choosing Wisely grant, the partners will collaborate to reduce use of (1) imaging for nonspecific low back pain, (2) preoperative testing, and (3) antibiotics for viral-based upper respiratory illness.
Another grantee, the North Carolina Healthcare Quality Alliance, is partnering with the North Carolina Medical Society, Duke Medicine, Cornerstone Health Care, Blue Cross Blue Shield of North Carolina, and the State Health Plan for Teachers and State Employees. Over the course of their grant, these groups will focus on reducing (1) the use of antibiotics to treat viral infections in adults, (2) DEXA scans to measure bone density in women younger than age sixty-five and men younger than age seventy, (3) carotid artery stenosis screening in asymptomatic patients, and (4) routine annual Pap tests for women of average risk who are between the ages of thirty and sixty-five.
The Washington Health Alliance, a previous ABIM Foundation Choosing Wisely grantee, will continue to partner with the Washington State Medical Association, also a former ABIM Foundation grantee, and provider organizations including Group Health Cooperative and Swedish Health Services. They will target the overuse of (1) antibiotics for upper respiratory viral infections, (2) imaging for uncomplicated headaches, and (3) overly frequent Pap tests for women between the ages of thirty and sixty-five.
Working together, these groups (1) will make Choosing Wisely “real” for patients across America and (2) expect to drive measurable reductions in unnecessary care. Their work holds great promise, and we look forward to seeing what comes of it.
Related content:
“Foundations Supporting Stewardship of Health Care Resources through Medical Education and Training,” by Daniel Wolfson and Leslie Tucker of the ABIM Foundation, Health Affairs Blog, January 22, 2014.
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