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Comment & Response
April 2016

Choosing Wisely Recommendations Using Administrative Claims Data

Author Affiliations
  • 1Anthem Inc Office of Medical Policy and Technology Assessment, Chicago, Illinois
  • 2Anthem Inc RHI Clinical Analytics, Columbia, Maryland

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2016;176(4):564. doi:10.1001/jamainternmed.2016.0342

To the Editor The Choosing Wisely campaign marks a pivotal transformation in how physicians and clinical societies advocate for evidence-based clinical care, namely by encouraging discussion about what constitutes appropriate and necessary treatment. In an article by Rosenberg et al1 in a recent issue of JAMA Internal Medicine, 7 early Choosing Wisely recommendations were evaluated using a claims-based methodology to assess early trends in health care practice. As noted in the article, the analysis provides a valuable starting point for further evaluation of Choosing Wisely recommendations; however, such analysis is predicated on specialized expertise in developing clinically complex claims-based algorithms. In a related but separate project,2 an Anthem clinical analytics team reviewed Choosing Wisely recommendations to determine the technical feasibility and clinical appropriateness of developing a comprehensive set of objective measurements based on administrative claims data. Our feasibility project aimed to construct 2 sets of measures; the first, a set of measures to identify individuals who might benefit from conversations regarding unnecessary care (ie, individuals at risk but not yet identified as having received inappropriate care); the second, a set of measures to identify cases suggestive of scenarios outlined in Choosing Wisely recommendations (ie, inappropriate care). Of the 305 Choosing Wisely recommendations released as of May, 2014, 202 recommendations (66%) were developed into measures to identify individuals appropriate for a clinically driven decision-making intervention (ie, individuals deemed “at risk”); and 145 measures (48%) were developed to identify individuals representing the clinical scenario presented in the Choosing Wisely recommendation (ie, individuals who received inappropriate care). To assist academic researchers interested in measuring and quantifying the potential value of the Choosing Wisely campaign, complete technical specification logic of our measures are available online following an application for use under the “Choosing Wisely” header toward the bottom of the Anthem Blue Cross and Blue Shield web page.2

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