The Issue

Innovations in care delivery and payment methods may help improve the quality of care and slow medical inflation, but they are likely insufficient in countering the magnitude of healthcare’s rising costs. To reduce spending in a socially responsible way requires an informed public voice.

The title “Common Cents” reinforces the message that many people share in the cost and the benefit of health insurance (our 'common cents'). This is the appropriate perspective for tackling one of the most challenging aspects of health care today: when – if ever – is a medical test, treatment or device too expensive to be covered under the umbrella of health insurance? What is a responsible way to balance clinical effectiveness with the cost? Who should make those decisions and what should be taken into account? A CHCD op-ed reinforces this topic.

CHCD’s Common Cents Work

A Common Cents Approach to Health Care, Spring 2014 – CHCD conducted several intensive half-day discussions with the general public focusing on the over-use of ineffective or unnecessary medical care. Four provocative case studies illustrated the issue and were the centerpiece for the discussions:

  • Elective early deliveries
  • MRIs for uncomplicated low back pain
  • Surgical vs. medical approach to treating knee injuries
  • Using the ICU for dying patients

Read the Common Cents Summary Report. Marge Ginsburg also presented these findings at the annual summit of the Center for Value-Based Insurance Design at the University of Michigan in October. Watch the video. The findings from this project are being used to help inform a more extensive project on reducing low-value care.

Value-based Insurance Design (V-BID)?

June 2012 – CHCD completed a pilot project, Probing the public's views on V-BID, with partners in Michigan to see how average employees considered the pros and cons of using value-based insurance design as a tool for encouraging high-value health care and discouraging low-value health care.

Doing What Works

The public’s perspectives on reducing the use of unnecessary, harmful or wasteful healthcare services.

Now Released:

Full Report and Executive Summary

Project Summary

Solving the problem of overuse is not easy, and the public is understandably wary when policy leaders claim that “too much” health care is provided, rather than not enough. To assure that California healthcare policy takes into account the views and values of the public, Doing What Works (DWW) held ten half-day deliberative group discussions with 117 residents, all low-to-moderate income Medi-Cal, Covered California and CalPERS members.

The DWW results are informing the work of the Statewide Work Group on Reducing Overuse, a purchaser-led multi-organizational body committed to improving the quality and affordability of health insurance throughout the public and private sectors. DWW is also integral to a project led by Integrated Healthcare Association, which is implementing Choosing Wisely ® through healthcare organizations in northern and southern California.

See the Doing What Works Executive Summary or the Full Report.

The project was funded by the California Health Care Foundation and Kaiser Permanente National Community Benefit Fund.

CHCF, Kaiser Foundation

Webinar Replay

A webinar held May 19, 2016 and moderated by Jill Yegian, Ph.D., IHA Senior Vice President for Programs and Policy, provided an overview of the Doing What Works project's findings and discuss implications for provider, purchaser and payer efforts to reduce unnecessary care.
WEBINAR PRESENTERS
• Beccah Rothschild, M.P.A., Senior Outreach Leader, Health Impact Team, Consumer Reports
• Marge Ginsburg, M.P.H., Executive Director, Center for Healthcare Decisions
• Julia Logan, M.D., M.P.H., Chief Quality Officer, California Department of Health Care Services
• Lance Lang, M.D., Chief Medical Officer, Covered California

Click here to replay the webinar.

BLOG POSTS

Kevin Rodondi, PharmD and associate director of leadership at Healthforce Center refers to Doing What Works in his blog Patient-centered Care: Five Ways Clinicians Can Reduce Costs and Achieve Better Outcomes.

Jeff Rideout, MD and CEO of Integrated Healthcare Association writes in his blog Patient Trust in Physicians and Reducing Harmful or Wasteful Care, “But patients in the exam room do trust their physicians, and because of that sacrosanct trust, I’m more convinced than ever that without physician buy-in and leadership, we’ll make little headway in reducing unnecessary care”.

Jill Yegian, Ph.D., IHA SVP for Programs & Policy writes in her blog, The Art of the Possible: Getting Thoughtful and Constructive Public Views on Thorny Health Policy Issues, “The results of the Doing What Works project will help inform both the Workgroup on Reducing Overuse and IHA’s Choosing Wisely project to identify ways to balance patient choice and physician autonomy against the larger societal concerns of preventing harm and wasting finite resources.”

Alwyn Cassil, writes in her blog, Large California Purchasers Use Deliberation to Engage Public in Reducing Unnecessary Care, “While participants recognized that patients sometimes insist on unnecessary care, they believe physicians have a responsibility to say ‘no,’ when care is inappropriate."

Susan Perez, Postdoctoral Fellow, University of California, Davis, writes in her blog People are Talking" target="_blank">"...engaging consumers through a process called (public) deliberation has been eye-opening. It has fired my interest in how the public's voice can be brought to bear on health care policy issues that affect individuals as patients, taxpayers, and members of society."

Additional Publicity

One of our partners in the Choosing Wisely campaign, the National Hospice and Palliative Care Organization, has written an article about the DWW report on their "eHospice/USA" site. You can find it by clicking here:

Community Forum project (2010-13)

Public deliberation on comparative effectiveness research (CER)

Project Summary

CHCD worked with the American Institutes on Research implementing a project for the Agency for Healthcare Research and Quality (AHRQ) to seek a societal perspective on some key issues related to CER.

The Community Forum Deliberative Methods Demonstration developed, fielded, and evaluated four distinct types of deliberative approaches. The demonstration convened 76 groups and more than 1,000 participants, including members of several AHRQ priority populations (Hispanics, African-American women, and the elderly). Participants deliberated on the use of evidence in healthcare decision-making. The study is the most comprehensive evaluation of deliberative methods to date, and provides insights regarding an issue central to AHRQ’s research.

Project Results

Getting Good Value (2006)

Consumers Debate Costly Treatments

Project Summary

In response to a growing concern about the high costs of some medical treatments, CHCD engaged 27 groups of Northern California consumers in thought-provoking discussions about whether new high-tech medical treatments are always worth their cost. Almost 300 participants discussed whether society should begin looking at the value (the relationship between cost and benefit) of new procedures and drugs when considering them for insurance coverage. Results reported in Health Affairs and to an AHRQ-sponsored committee.

Project Report

Visible Fairness (2002)

Cost-Effectiveness as a Criterion for Medical and Coverage Decisions

Project Summary

This regional project was a community-wide dialogue on the role that cost plays in healthcare treatment and coverage decisions. Designed to gauge the public’s notion of cost-effectiveness as a component of medically necessary care, this was an extension of Stanford University’s earlier report on Defining Medical Necessity. Consumers weighed in on one of society's most difficult dilemmas: how to balance the medical needs of individuals with those of the larger community. CHCD conducted a written survey of 500+ physicians, held 25 discussion groups with 263 consumers and commissioned a 500-person random phone survey of the general public. Results were presented in CA and nationally. To see how average consumers debate a controversial health policy issue, see this 8½ minute video.

Project Report

Publications

Hospital Quality (2010)

How and why the public cares about certain quality domains

Project Summary

In an effort to help leaders of the California Hospital Assessment and Reporting Taskforce (CHART) evaluate the usefulness of its work to consumers, CHCD asked diverse groups of consumers throughout California to consider four quality domains: clinical effectiveness, patient safety, responsiveness to patients and efficiency. Using an Audience Response System (keypad voting) and a series of case scenarios, project participants were asked to prioritize the relative importance of these domains and discuss the rationale for their decisions. This CHCD report has been distributed nationally to organizations sponsoring hospital public-reporting websites.

Project Report

(1994-2000) End-of-Life Decisions and Care in Hospitals

CHCD began the ECHO (Extreme Care Humane Options) project in 1994 to find community consensus on the often difficult subject of using life-sustaining treatment for those who are terminally or irreversibly ill. This was a community-wide project involving nearly 1,000 local residents in discussion groups; a telephone survey; and committees of healthcare professionals.

In January 1997, the ECHO Community Recommendations were published targeted to acute care hospitals in the greater Sacramento region. More than 6,500 copies of the recommendations were mailed on request to healthcare facilities throughout the country. Almost every hospital in the Sacramento region adopted the recommendations and instituted changes in their policies, practices and programs.

End-of-Life Guidelines for Nursing Homes

Following the publication of the ECHO Community Recommendations, CHCD convened a statewide ECHO Long-Term Care task force to address this same issue in skilled nursing facilities. In January 2000, the ECHO Nursing Facility Recommendations were published and mailed by the California Department of Health Services, Licensing and Certification, to all 1,400 skilled nursing facilities in the state. This task force became the core group that formed the Coalition for Compassionate Care of California.

The Coalition for Compassionate Care of California (CCCC) is a statewide partnership dedicated to the advancement of palliative medicine and end-of-life care in California.

Instrumental in forming CCCC in 1998, CHCD provided leadership to the organization through 2012:

  • Served as co-PI from 1999-2004 during the organization’s initial RWJ Foundation grant period.
  • Led its Public Engagement initiative from 1999-2006.
  • Served on CCCC’s newly-established 501(c)3 Board of Directors from 2006-12.

Related CHCD work:

  • Produced a 2009 white paper highlighting the work of eight CCCC community POLST coalitions.
  • Wrote a 2011 issue brief on a regional collaborative effort to improve advance care planning and end-of-life care in Sacramento area nursing homes.

From 1994-2013, CHCD played a leadership role in local, state, and national activities related to improving end-of-life care. Through ECHO - Extreme Care Humane Options - educational materials, trainings and policy recommendations, CHCD educated thousands of citizens, trained hundreds of local health professionals and faith leaders, and worked with healthcare organizations to implement new end-of-life policies and practices. By 2014 CHCD had transitioned its education and outreach activities to other organizations, including the Coalition for Compassionate Care of California (CCCC).

Summary of CHCD activities:

  • Advance Care Planning/POLST speakers bureau. Now being coordinated by the Greater Sacramento Health Ministry Network (GSHMN); contact Susan Carson by email at: Susan.Carson@DignityHealth.org
  • Consumer education materials. Now available through Coalition for Compassionate Care of California
  • Finding Your Way booklets, can be viewed and ordered from the CCCC website.
    To view on their website: Click Here. Then click on the Talking About Advance Care Planning button. That will take you to a PDF of the booklet.
    To purchase quantities in their online store: Click Here.
  • Annual Partners in Caring seminar for faith leaders. Now being sponsored by GSHMN
  • Regional POLST Coalition (2009-2012)
  • Sacramento regional Alliance (2001-2010)
  • EOL - Coalition for Compassionate Care"> Statewide CCCC participation (1998-2012)
  • 2011 – wrote an issue brief on a regional collaborative effort to improve advance care planning and end-of-life care in Sacramento area nursing homes
  • 2009 – produced a white paper highlighting the work of eight community POLST coalitions
  • 2005 – co-authored an article in Journal of Palliative Medicine: Improving End-of-Life Care in Nursing Facilities: The Community State Partnership to Improve End-of-Life Care - California

The Coalition for Compassionate Care of California (CCCC) is a statewide partnership dedicated to the advancement of palliative medicine and end-of-life care in California.

Instrumental in forming CCCC in 1998, CHCD provided leadership to the organization through 2012:

  • Served as co-PI from 1999-2004 during the organization’s initial RWJ Foundation grant period.
  • Led its Public Engagement initiative from 1999-2006.
  • Served on CCCC’s newly-established 501(c)3 Board of Directors from 2006-12.

Related CHCD work:

  • Produced a 2009 white paper highlighting the work of eight CCCC community POLST coalitions.
  • Wrote a 2011 issue brief on a regional collaborative effort to improve advance care planning and end-of-life care in Sacramento area nursing homes.