At the same time the Integrated Healthcare Association (IHA) was selected as a Choosing Wisely grantee in 2015, a work group in California was forming to magnify efforts to reduce low-value care on a statewide basis. This work group has since grown into Smart Care California, a public-private partnership led by three of California’s largest state purchasers, which collectively purchase or manage care for more than 16 million Californians (40 percent of the state). Smart Care California is a multi-stakeholder effort that works with public and private purchasers, health plans and clinicians as well as patient groups to promote safe and affordable care, and that includes advancing the goals of Choosing Wisely.
“We started with the Choosing Wisely recommendations as our initial guidelines and realized that if patients are being told that they might not need a test or treatment, then they need options on what they can do for their situation,” said Jennifer Wong, project manager with Smart Care California. “We branded ourselves as Smart Care to emphasize that we need to be doing less in some areas and more in others to make sure we are delivering appropriate care.”
Smart Care California created an online dashboard, using data from existing statewide sources, to track progress toward goals in three areas:
- C-section for low-risk, first-time births
- Opioid prescribing
- Imaging for low-back pain
Data comparing 2015 and 2016 show that fewer people are being prescribed opioids and fewer people are on high-dose opioids. The dashboard also shows that the statewide average for low-risk, first-birth C-section rates is trending toward the federal Healthy People target of 23.9 percent, and that more hospitals are joining the California Maternal Quality Care Collaborative, which works directly with hospitals and clinicians to improve maternity care.
In 2017, Smart Care California also published a menu of payment options to align payment to support reducing unnecessary C-sections, published a health plan and purchaser checklist of approaches to combat the opioid epidemic, and published payer and provider strategies to support the adoption of opioid safety initiatives. Data from 2017 are expected to be posted later this year.
Throughout 2018, Smart Care California will work to identify measures and existing data for low-back pain imaging and identify payer and provider best practices for ensuring patients get the most appropriate care for low-back pain.
“Back pain is difficult to tackle since there is no current statewide measurement for this area,” Wong said. “We want to expand this area to see if we can deliver a consistent model of care for people with low-back pain, and we eventually want to have more granular data at the health plan and provider level to identify variation in the care that is delivered and understand why.”
Wong said their workgroup attendees are driven to improve quality. This year, Smart Care California is looking to reach more stakeholders, especially those who have not previously engaged, to support payer and provider implementation of effective strategies identified by the work group and to connect more patients to useful resources, such as the Choosing Wisely materials.
“We didn’t want to focus on areas that individual stakeholders could tackle on their own” she said. “Instead, we wanted to find areas that required collaboration and an alignment of priorities between purchasers, health plans and providers. But we are not forcing a one-size-fits-all model. The value is bringing multiple stakeholders on this quality improvement journey.”