Doubling Down for Appropriate Care

Massachusetts Health Quality Partners  (MHQP), a statewide regional health improvement collaborative, has been a leader in efforts to spark conversations about appropriate care in Massachusetts through both Choosing Wisely® and the MHQP Practice Pattern Variation Analysis (PPVA) program.

In 2013, MHQP was awarded a grant from the ABIM Foundation to spread the Choosing Wisely campaign in Massachusetts. At that time, MHQP was also leading an initiative to examine practice pattern variation, using a model and philosophy developed by Howard Beckman, MD, of Focused Medical Analytics (now Eagle Dream Health).

“Choosing Wisely and PPVA are both interested in identifying areas where people may be receiving low-value services and encouraging practitioners to think about that,” Dr. Beckman said. “I see them as complementary.”

MHQP’s Choosing Wisely efforts included the development of a statewide campaign and website focused on promoting conversations between physicians and patients around five specific recommendations, including imaging for lower back pain, imaging for uncomplicated headache, early induction in childbirth, colorectal cancer screening and antibiotic overuse. More than 20 participating organizations disseminated information to providers, patients and consumer groups during a month-long awareness initiative aimed at reducing unwarranted use of diagnostic imaging.

Using data from the Massachusetts All Payer Claims Database, MHQP’s PPVA initiative identified 40 high-cost and high-volume conditions and then analyzed differences in utilization associated with specific services that were cost drivers.

“We can’t judge from claims data if the variation is appropriate or not appropriate,” Dr. Beckman said. “But we can show that there is unexplained variation and raise questions about why. It creates great conversations among physicians.”

MHQP convened a multi-stakeholder group of physicians from provider organizations and health plans to select three areas of focus for MHQP’s PPVA work from among the 11 with the most variation. Conditions selected were ischemic heart disease, surgery for back pain and fetal imaging after the first trimester.

While PPVA and Choosing Wisely are separate initiatives, both approaches have been important in MHQP’s efforts to stimulate dialogue with providers and patients about appropriate care.

“PPVA offers an opportunity for physicians to play a leadership role in driving appropriate use of health care resources, while the Choosing Wisely approach resonates with providers and patients alike as a way to empower shared decision making,” said Janice Singer, Vice President of Programs at MHQP. “MHQP is committed to working with a collaborative model that involves providers and patients to achieve high value care and improved patient outcomes.”