Is Shared Decision Making the Core of Value-Based Care?
As the healthcare industry shifts toward patient-centered care and a fee-for-value model, shared decision making (SDM) is key in facilitating that shift. The SDM model helps patients understand their options as well as the benefits and risks of each option, so they can have informed and effective conversations with their providers.
Shared decision making is a current topic of discussion at both at the state and federal level. States are using SDM as a model for patient-centric care. For instance, from 2007-2011 the state ofWashington passed legislation to promote shared decision making as evidence of informed consent, and this year launched a process for certifying decision aids. The states of California, Connecticut, Maine, Minnesota, and Vermont have also passed legislation on SDM. At the federal level, SDM is a key tenet of the Accountable Care Act (ACA), which authorizes a program designed to help people make informed health decisions with their providers.
Financial incentives models between payers and providers also promote the use of SDM tools and principles. In some models, SDM is part of the preauthorization process, and patients are incented to use a decision aid as part of their conversations with their providers.
Decision aids as tools in SDM
Decision aids are patient health tools that explain treatment and care choices and help patients work with their doctors to make decisions about their healthcare. They are used when there is more than one viable treatment option and the right choice depends on how a patient feels about the benefits and risks as well as the patient’s values and preferences.
What are the IPDAS standards?
The International Patient Decision Aid Standards Collaboration (IPDAS), a group of global researchers, clinicians, and stakeholders, has established internationally approved standards to assess the quality of patient decision aids. The IPDAS checklist includes criteria on whether the decision aid:
- Includes information about options in sufficient detail for decision making?
- Presents probabilities of outcomes in an unbiased and understandable way?
- Provides methods for clarifying and expressing patients’ values?
- Includes structured guidance in deliberation and communication?
- Presents information in a balanced manner?
- Was developed through a systematic development process?
- Uses up to date scientific evidence that is cited or referenced?
- Discloses conflicts of interest?
- Presents information in plain language?
Decision aids: results and success in practice engagement
Health Dialog decision aids were developed in collaboration with the Informed Medical Decisions Foundation, a key contributor to the IPDAS standards, and are regularly reviewed and updated by Harvard Medical School doctors. The library of shared decision making videos, print, and online content covers topics ranging from managing chronic back pain and diabetes, to treatment choices for prostate cancer and hip osteoarthritis.
The decision aids are evidence-based, unbiased, and present the benefits and risks of all treatment options in easy-to-understand language and visuals. Videos feature patient perspectives, with real patients explaining how and why they made their treatment decisions. Health Dialog decision aids have won numerous industry awards for media and communication excellence.
While the use of decision aids at the state and federal level is fairly new, decision aids have been used for a long time in the private sector. Health Dialog shared decision making tools have been empowering patients to manage their care and make informed decisions for nearly two decades. Below are some results of their use:
Case Study: Group Health
An independent study conducted by Group Health and published in Health Affairs, titled “Introducing Decision Aids at Group Health Was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs,” analyzed results from the use of Health Dialog’s shared decision making tools. Results from the study showed that:
- Knee replacement surgeries declined by 38% after 18 months
- Hip replacement surgeries declined by 26% after 18 months
- Costs declined by 12-21% after 6 months
Case Study: Massachusetts General Hospital
In 2005, a large multi-year effort was launched to use patient decision aids at Massachusetts General Hospital in routine primary care. The program focused on two implementations: 1) clinician ordering of decision aids and 2) patient-guided ordering of decision aids. From 2005-2015, more than 900 clinicians and staff were trained in shared decision making and over 28,000 Health Dialog decision aids were used to guide patient decision making. The shared decision making initiative at MGH concludes that, in addition to ordering volume, measuring decision quality is an important metric to assess the program’s effectiveness. To that end, the program is engaging patients in the development of provider decision support tools and in assessing decision quality.
As the industry shifts to a value-based reimbursement model, shared decision making helps drive down healthcare costs and improves total population health. Shared decision making is here to stay and when implemented effectively, will be key to high-value care -- reducing utilization and costs, and increasing patient knowledge and satisfaction.