Guest Commentary: Shared decision-making could cut costs and improve patient outcomes

Most of the nation's largest health plans and major hospitals and medical groups offer patients decision-making tools, such as videos and pamphlets, to educate them about the risks and benefits of various treatment options for dozens of medical conditions. Sometimes these materials are used with patient coaching.

Experts say such tools lead to increased patient satisfaction, more efficient use of clinicians' time, and even reduced use of some treatments, particularly elective surgery.

But it hasn't always been easy to get physicians to use these decision aids with patients, given disorganized systems of care and fee-for-service incentives to provide more procedures and services.

Now, a little-noticed provision of the Patient Protection and Affordable Care Act aims to expand and test the use of decision aids and shared decision-making between patients and their physicians. Section 936 will establish a process to certify decision aids, award funding to produce and update aids, create shared decision-making resource centers, and provide grants to providers for development, use and assessment of these aids.

In addition, the Center for Medicare & Medicaid Services' new rules on meaningful use of electronic health records include requirements that EHRs offer patient education resources.

Seattle-based Group Health Cooperative launched a major shared decision-making program for its members last year. Patients with any of 13 conditions are asked to watch a video and read a booklet on that condition produced by Health Dialog, a company in Boston. Then they discuss it with their medical specialist.

Hospital systems, clinics, physician groups and academic medical centers are participating in similar tryouts around the country. Health Dialog and its affiliated nonprofit, the Foundation for Informed Medical Decision Making, are helping fund the demonstrations. States such as Washington, Vermont and Maine have passed laws to promote shared decision-making.

Most of the nation's largest health plans offer patients similar tools--interactive Web-based programs produced by Boise-based Healthwise. Such plans include Kaiser Permanente, Aetna, Cigna, and Wellpoint, according to Healthwise CEO Don Kemper. Plans offer Healthwise information on their Web sites and through their nurse call centers.

"Our experience pretty consistently is that when patients are well-informed, they and their doctors tend to make more conservative choices, and we see a 25 percent reduction in the choice of surgery," said Dr. Lance Lang, Health Dialog's senior medical director.

On the other hand, he noted, shared decision-making could lead to appropriate utilization increases in some areas, such as spinal stenosis, where patient outcomes improve and long-term costs are reduced by doing the operation earlier. "This is not about denial of care or overriding the doctor's decision," Lang said.

Many Americans need help deciding what's the best medical course, and busy physicians say they can use help in educating patients about their options. This is one type of delivery reform that could save money and improve quality without stirring up political controversy. It's a no-brainer, and deserves widespread support and expansion.

Editor's note: Harris Meyer is a journalist based in Yakima, Wash. who has won many awards for his reporting, including the National Institute for Health Care Management Award and the Association for Health Care Journalists Award.

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