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Health Affairs:
Enhanced Support for Shared Decision Making Reduced Costs of Care for Patients With Preference Sensitive Conditions

In the February 2013 issue of Health Affairs, Health Dialog published a study showing that providing Shared Decision Making-based health coaching for patients with conditions that frequently have major treatment decisions associated with them, reduces the overall costs of healthcare, hospitalizations, and surgeries dramatically.

The study demonstrated “that a broad population health management program that targeted people with high risk of future costs – including people with a variety of chronic conditions or at risk for surgery – lowered health care use and cost for the entire population.” The study found that patients who received enhanced support had 5.3 percent lower overall medical costs; 12.5 percent fewer hospital admissions; and 9.9 percent fewer preference sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries.  


Read the full article here.



Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about treatments selected. Although recent federal and state policies pursue expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a year-long randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced support group had 12.5 percent fewer hospital admissions (p < 0.001) than the usual support group, and 9.9 percent fewer preference-sensitive surgeries (p=0.04) including 20.9 percent fewer (p = 0.02) preference-sensitive heart surgeries.  These findings indicate that support for shared decision making can generate savings.  They also suggest that a “remote” model of support combining telephonic coaching with decision aids, for example -- may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for direct involvement of regular medical care team members.


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