Choosing Wisely and State Innovation Models Align in Maine

The Choosing Wisely® campaign and the State Innovation Models Initiative (SIM) both aim to reduce overuse and improve quality of care. The state of Maine is capitalizing on that alignment to help improve health care for its residents.

The SIM Initiative, led by the Innovation Center of the Centers for Medicare & Medicaid Services (CMS), has given grants to states to help plan, design and test innovative service delivery and payment models to aid the progress of health system reform. The SIM initiative pushes states to engage their community and collaborate with private insurers, major employers, Medicaid, Medicare and key stakeholders – such as public health and consumer advocates – to help transform health care delivery in their state.

Maine is one of six states that were awarded funding in Round One to actively test an innovative model of collaboration as part of the Model Testing Awards. Over three years, the state of Maine will use a little more than $33 million to support the formation of multi-payer accountable care organizations (ACOs) that are committed to meeting established quality standards for clinical care and reporting on their performance to the public. In addition, Maine plans to implement payment reform across public/private payers; spread the patient-centered medical home model of enhanced, integrated primary care; and promote cost transparency.

Maine Quality Counts (MQC) is working to advance Choosing Wisely through a grant from the ABIM Foundation supported by the Robert Wood Johnson Foundation. As a partner and subcontractor of the state of Maine for its SIM award, MQC is using SIM funding to provide quality improvement support for the state’s Health Homes initiative, as well as to support consumer engagement efforts. As part of this work, MQC will launch a set of Patient Provider Partnership (P3) Pilots with a goal of improving health care quality and reducing avoidable costs through patient engagement in shared decision-making. One set of pilots will use Choosing Wisely as a basis for promoting more productive patient-provider conversations and engaging patients in shared decision-making.

“We need to fully engage patients in their care and patient engagement starts with giving patients the tools they need to work with their health care provider and ask questions. Patients without the skills to manage their health care incur costs up to 21 percent higher than patients who are highly engaged in their care,” said Dr. Lisa Ryan, P3 Pilot Physician Consultant.

With grant support from the ABIM Foundation, MQC had previously established four Choosing Wisely pilot sites working on improving performance related to several Choosing Wisely recommendations. With the four additional P3 pilot sites funded by SIMs, Maine will have eight sites focused on clinical implementation of the Choosing Wisely recommendations and interventions to promote physician/patient conversations on avoiding overuse. The four practices participating in the SIM-funded P3 pilots will attend learning sessions, develop plans to incorporate shared decision-making tools and patient aids into their practice workflow, and engage and empower patients in the visit.

“Choosing Wisely has given us a great opportunity to support the SIM goals of more actively engaging patients in their care to improve quality and control costs,” said Lisa Letourneau, MQC Executive Director. “Choosing Wisely tools, such as the condition-specific materials from Consumer Reports and the ‘Five Questions to Ask Your Doctor’ poster, provide incredibly helpful decision aids for patients and help to promote productive conversations between them and their clinicians.”