Resource Stewardship Initiative

The Resource Stewardship Council was recently formed by Blue Cross Blue Shield of Michigan to encourage physicians to improve health care decision making when using medical services, procedures and tests that have been identified as areas of over-utilization. The Resource Stewardship Initiative (RSI) promotes the use of evidence-based medicine when making health care stewardship decisions. The RSI also encourages conversations between physicians and patients about appropriate and necessary care. The Physician Alliance is a member of this council, represented by our chief medical officer, Dr. Karen Swanson.wqdwdwqd

The council identified 17 medical services, procedures and tests that may be overused or of questionable value and that have significant variation in use among physician organizations in Michigan. Many of these “over utilized” services are very similar to Health Effectiveness Data Information Set (HEDIS) measures, a common metric system that payers use to evaluate a practice’s quality performance. Each physician organization was tasked to select two to four target areas to help their practices identify patterns of poor performance and overuse and help practices develop approaches to improve resource stewardship.

From the 17 potential over utilized services, The Physician Alliance identified three key targets for reduction in utilization by our physicians based on current physician scores and TPA’s ranking among other physician organizations in these specific areas.

TPA’s focus areas are:

  1. Decrease use of imaging for low back pain (HEDIS METRIC)Click for more information.
  2. Decrease pap smears in women under 21 years of age (HEDIS METRIC)Click for more information.
  3. Decrease antibiotic use for adults with acute bronchitis (HEDIS METRIC)Click for more information.
These selections are supported by documented healthcare standards, such as HEDIS. (Poor performance on HEDIS metrics results in reduced pay for performance revenue in many programs.) Decreased use of these services can lead to higher quality of patient care, increased patient safety, improvement in the practices pay for performance revenue, and decrease in overall healthcare costs.
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