Indiana Jones and the Last Crusade

By Dr. Charlie Miraglia

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As healthcare continues its quest toward the holy grail of patient satisfaction and value-based care, difficult decisions must be made by providers. Decisions about how best to utilize precious (meaning high cost) resources they’ve been so accustomed to ordering (some might say, indiscriminately in the past). I think the Grail Knight in the hit movie, Indiana Jones and the Last Crusade, put it best – “You must choose. But choose wisely, for as the true Grail will bring you life, the false Grail will take it from you.”

Okay, that may be a bit melodramatic, but the point stated more simply is that there is always a choice involved in appropriate utilization of healthcare resources. The question that remains is:

“How do providers order only the right tests, procedures, etc?”

“Right” meaning – only the ones that are truly needed to bring value to the experience and result in better clinical outcomes. That leads us to the consideration of the “less is more” movement in healthcare.

Just to be clear, the focus is definitely to avoid any harm coming to patients and not just cutting costs. But if tests and procedures that deliver almost no value, or perhaps result in avoidable care or even unnecessary risks, are targeted, wasteful healthcare spending can be reduced. It has been estimated that overutilization of low-value services accounts for almost a third of the $2.8 trillion annual healthcare spend in the U.S. For those of you doing the math…that’s around $933 billion. Add to this the fact that although the U.S. spends more than any other western country in the world on healthcare, outcomes are the same or worse.

So let’s go back to the opportunity side of the equation. The good news is that the medical profession has begun to engage with this issue: admitting to overuse and looking for evidence that can be used to support this “less is more” approach. Remember, many orders for tests and procedures are the result of the physician’s malpractice concerns, or because the patient has insisted that something be done. With increasing availability of real-time data, better decisions can be made, and both patients and providers can be educated about what appropriate utilization means.

For example, many hospitals have begun to include automatic reminders in the Electronic Medical Record when certain tests are ordered. The goal in most cases is not to stop the physician’s ability to order, but to make him or her think carefully about whether it’s needed under the current circumstances. More recently though, technology has evolved to the point where data rich patient profiles are available. icon_roles-2These profiles include diagnostic results, demographic data, insurance coverage, etc. Even more intriguingly, cognitive computing capabilities now exist, making it possible to analyze emails, social media, and surveys for personality insights. Having access to both diagnostic and behavioral data and personal preferences for each patient inevitably leads to a truly personalized experience.

Patients will also need to be engaged with their physicians and take more responsibility for their care. Weighing the benefits and risks and considering personal preferences should be a joint exercise with providers, patients, and their families. In addition, with access to more extensive data sets and having decision support mechanisms in place, physicians can clarify the benefits and potential limitations of tests and procedures for patients. This will lead to more productive discussions and more satisfied healthcare consumers.

Ultimately, it comes back to the question of choice. Providers need to make better choices based on data and evidence, and patients and their families need to be better engaged and educated so that they can make better choices for themselves. The goal seems clear: to avoid the outcome suffered by the villain, Donovan, in the Indiana Jones film. To once again quote the Grail Knight (after Donovan drinks the false Grail and perishes), “He chose…poorly”.

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