Reducing Low-Value Care in Vulnerable Populations – Clinician Engagement

The resources below can help safety-net practices, hospitals and systems engage their clinicians in Choosing Wisely. They have been broken into sections by time commitment:

• If you have five minutes, check out our top five insights from each area.
• If you have twenty minutes, read sample scripts, review tools or listen to a short podcast.
• If you have an hour to dedicate, read the source journal articles, watch a webinar or join our learning network to connect with others.

If you have five minutes…

Five things to consider when working:to decrease low-value care when serving vulnerable populations:

Keep the focus of clinician-patient conversations on improving patient safety (vs. decreasing health care costs).

Be sure to present your recommendations respectfully and non-judgmentally.

Remember that using less resources on LVC frees up more resources for high-value care, particularly in value-based and capitated payment models.

Be aware that most patients value your time with them more than the tests or treatments you order; patients generally appreciate and are open to honest conversations.

Consider coupling conversations that focus on reducing LVC with complimentary messages re: opportunities to increase high value care (e.g. preventive care).

If you have 20 minutes…

READ:

• Review & consider using some of the great tools in the Quality Counts’ Choosing Wisely Implementation Toolkit to integrate CW into your workflow.
• White paper on focus group findings from “Testing Choosing Wisely Campaign Concepts with Low-Income Populations”
• “5 Things About Choosing Wisely and the Safety Net” (from “Updates From The Field”)
• “Leveraging Choosing Wisely as a Tool for Achieving Health Equity” by CT Choosing Wisely Collaborative

WATCH:

• Watch this PCPCC webinar, “Implementing Choosing Wisely – Practices Share Lessons Learned”
• Slides from the webinar “Being a Physician Champion for Choosing Wisely in an FQHC,” with Dr. Robert Kolker.

DO:

• Use academic detailing to have 1:1 conversations with clinicians to enlist their help to become CW champions
• Place the Choosing Wisely “5 Questions” in your clinical settings.
• Place “Commitment Posters” in patient exam and waiting rooms
• Use sample scripts developed for practice staff and clinicians to use with patients when having CW conversations (See page 4 of Quality Counts’ CW Implementation Toolkit)

If you have 60 minutes…

READ:

• Treating, Fast and Slow: Americans’ Understanding of and Responses to Low-Value Care, Milbank Quarterly, 95(1), 2017.
• Low Value Medical Services in the Safety Net Population, JAMA Int Med, 177(6), 2017.
• Interventions Aimed at Reducing Use of Low-value Health Services, Medical Care Research & Review, 74(5), 2017.
• Engaging Physicians in Change: Results of Safety Net QI Program to Reduce Overuse, AmJMedQual, 26(1),2010.

WATCH:

• “Acting as a Physician Champion for Choosing Wisely in an FQHC” with Dr. Robert Kolker, CW Learning Network Webinar, April 2019.
• “Engaging Providers to Reduce Medical Overuse,” CW Learning Network Webinar, August 2018

DO:

• Present the Choosing Wisely slide deck. (TK)

If you need assistance with this toolkit or implementing Choosing Wisely in your practice or system, please contact Kate Carmody at kcarmody@abim.org.