Power to the patient

People's lives today are full of choices. They know what they like. They know what matters to them. They trust their judgment and check with their gut. But when it comes to choices related to their health, they could use a little help.

There's nothing quite as personal and important to patients as their health. However, they are not experts in navigating the healthcare maze. While there is no shortage of ideas and advice, it's often confusing. They are looking for the best care possible, and need help with the questions as much as the answers.

One proven solution to arming patients with the right questions and answers is shared decisionmaking. Shared decisionmaking is a collaborative approach where patients are provided with evidence-based information on treatment choices and are encouraged to use this information to have an informed dialogue with their physicians to help them make the healthcare decisions that best align with their values, preferences and lifestyle. It has been gaining momentum in recent years, specifically as the healthcare industry strives to meet the requirements of the Patient Protection and Affordable Care Act and as payment reform has transitioned to paying for value creation instead of paying for services or procedures (fee for service).

Shared decisionmaking often involves using decision aids—written materials, online modules and/or video—to present information about treatment options that help the patient evaluate potential risks and benefits. After using aids, patients are better prepared to have a more informed discussion with their doctor about their options. The most effective decision aids are those that provide relevant facts individuals need to manage their health conditions and make important treatment decisions, and provide video of real patient perspectives regarding the pros and cons of a particular procedure.

Patients who are prepared with information on their condition and options, and who have been encouraged to think about their preferences, are better able to work with their physicians in managing their health. That requires identifying individuals early in the decision process and understanding their unique situation to provide the right level of support and guidance.

When this approach is applied to populations, quality and satisfaction go up while costs go down. Health plans, major hospital systems and large physician practices that adopt shared decisionmaking are realizing true value and benefit.

A 2013 study published in the February issue of Health Affairs showed that providing shared decisionmaking-based health coaching for patients with conditions that frequently require major treatment decisions reduces the overall costs of care, hospitalizations and surgeries significantly. The study, “Enhanced support for shared decision making reduced costs of care for patients with preference sensitive conditions,” found that patients who received enhanced support had 5.3% lower overall medical costs than patients who received the usual level of support. Also, the enhanced support group had 12.5% fewer hospital admissions than the usual support group, and 9.9% fewer preference-sensitive surgeries, including 20.9% fewer preference-sensitive heart surgeries.

A 2010 New England Journal of Medicine study of Health Dialog's program showed it produced net savings of $6 per member a month across a broad population with a 10.1% reduction in annual hospital admissions. Group Health, a not-for-profit healthcare system based in Seattle, adopted shared decisionmaking enterprisewide and achieved significant improvement in patient-decision quality and also increased patient and provider satisfaction. Another study, this time in 2012 in Health Affairs, showed Health Dialog's decision aids were associated with a 38% and 26% reduction in hip and knee replacements at Group Health.

These studies were done on patients served by shared-decisionmaking programs sponsored by health plans. Early adopter-provider practices offered shared decisionmaking because they felt that it was the right thing to do for their patients. However, because it often resulted in more conservative treatment choices, these providers had to risk potentially lower incomes because of the perverse incentives of fee-for-service medicine.

However, the market is transitioning to fee-for-value compensation for providers. This system will offer financial rewards for patient-centric, efficient medical care.

Scott & White Health Plan, based in Texas and one of the nation's largest multi-specialty group practice systems, has implemented a shared-decisionmaking program that provides decision aid tools and health coaching solutions to 160,000 members and plan physicians. Kaiser Permanente Southern California, Massachusetts General Hospital, Boston, and the Dartmouth-Hitchcock healthcare system, Lebanon, N.H., are also using Health Dialog's approach to improve care and reduce costs. Those market leaders have chosen to provide the personalized support that shared decisionmaking offers to patients who are facing important health decisions.

Shared decisionmaking is unquestionably the right thing to do for patients to improve care, reduce costs, and most importantly, empower patients to get the care that is right for them.

Dr. Peter D. Goldbach is the chief medical officer of Health Dialog, a for-profit venture created by the Dartmouth Institute for Health Policy & Clinical Practice.