Reducing Unnecessary Medical Care

Delivering high quality care is central to a physician's mission and identity...understanding how you perform on best-practices metrics is fundamental to improving.

Marty Makary, MD, MPH,
Professor of Surgery and Health Policy and Management, Johns Hopkins Medicine

Value to risk-based providers and payers

Knowing who delivers more appropriate care is critical to improving physicians and improving healthcare. Our landmark study using “Dear Doctor” letters sharing physician performance on a single Mohs surgery measure led to $22 million in savings for the Centers for Medicare & Medicaid Services in five months, generating a healthy return on investment of 145:1.

We are on our way to identifying the $265 billion spent in the United States annually on unnecessary care. Our clinically-validated Appropriate Use Measures attribute performance results to individual physicians, enabling healthcare organizations – accountable care organizations, risk-based providers, and commercial and government payers – to act on these insights and capture value.

Physician Engagement

  • Understand areas of strength and opportunities for improvement across your network
  • Identify outliers for one-on-one discussions and a ‘second look’ at clinical decisions
  • Nudge physicians to improve, using peer-comparison as intervention
  • Promote peer-sharing between physicians in your group or network

Network Management

  • Identify improvement opportunities and prioritize clinical initiatives for your specialists
  • Steer patients to more appropriate specialists using Centers of Excellence and other referral management and patient navigation tools
  • Integrate appropriateness measures into specialist profiling programs
  • Incent improved appropriateness via quality-based compensation programs
  • Optimize utilization management processes by rewarding high-performers with an appropriateness FastPass

Learn more about how Practicing Wisely can work in your organization

Learn more about how Practicing Wisely can work in your organization

Importantly, Practicing Wisely reports do not only provide an assessment of a physician’s practice, they serve as a tool physicians can use to improve their practice of medicine.

Thomas Simmer, MD, Chief Medical Officer, BCBSM