Health Plan Recommends More Interventions for Tangible Results With Choosing Wisely

Reducing unnecessary, wasteful clinical procedures and treatments is the foundation of the Choosing Wisely campaign that was initiated in 2009 by the National Physicians Alliance and funded by the American Board of Internal Medicine. The campaign has come a long way since its launch and subsequent expansion in 2012, with more than 70 lists and 400 recommendations by various medical societies on judicious use of tests, services, or medications when there would be a low value return for patients. However, a new analysis by the health plan provider Anthem has identified the need for more widespread implementation of these interventions aimed at reducing healthcare utilization.

Published in the journal JAMA Internal Medicine, the authors from Anthem Inc and its subsidiary HealthCore Inc, analyze claims data for individuals enrolled with Anthem-affiliated commercial health plans. The following services—some of the earliest of the Choosing Wisely recommendations—were selected:

• imaging tests for uncomplicated headache
• cardiac imaging without history of cardiac conditions
• low back pain imaging without red-flag conditions
• preoperative chest x-rays with unremarkable history and physical examination results
• human papillomavirus (HPV) testing for women younger than 30 years
• use of antibiotics for acute sinusitis
• use of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for members with hypertension, heart failure, or chronic kidney disease.

When the authors analyzed the number of members who had quarterly medical and/or pharmacy claims for any of the above services over a 2- to 3-year period through 2013, they observed a decline only for 2 of the listed services: imaging for headaches (which reduced from 14.9% to 13.4%, P<.001) and cardiac imaging (which reduced from 10.8% to 9.7%, P<.001). Two of the services actually had an upward trend: use of NSAIDs for the defined conditions increased from 14.4% to 16.2% (P<.001) and HPV testing in younger women increased from 4.8% to 6.0% (P<.001).

The authors conclude that despite the statistically significant changes observed (attributed to the large sample size), they are not sure of the clinical implications of these changes, but recommend additional interventions such as data feedback, physician communication training, clinician scorecard, patient-focused strategies, and financial incentives to ensure superior impact.