- Shared decision-making, or the practice of an informed patient participating in treatment decisions alongside her clinicians, may seem like a natural patient engagement strategy. After all, shared decision-making integrates the patient into the healthcare process and gives the patient more claim in her wellness journey.
But despite proven clinical efficacy, shared decision-making isn’t entirely widespread across the healthcare industry, says Peter Goldbach, MD, Chief Medical Officer for Rite Aid’s RediClinic and Health Dialog.
“Although shared decision-making has been around for quite a few years, and although there is a significant evidence basis about the expected outcomes of shared decision-making interactions, it is really more the exception than the rule in clinical practice today,” Goldbach said in a recent interview with PatientEngagementHIT.com.
“There are islands of excellence that do exist, specifically people that have taken an interest in shared decision-making,” Goldbach added, making a nod to SDM researchers and specialists.
Some medical professionals do believe they are practicing shared decision-making, but when Goldbach spends more time with the provider and breaks down the details of shared decision-making, it becomes clear that the art has not yet been perfected.
The healthcare industry landscape has never been conducive to integrating shared decision-making, Goldbach explained. Although shared decision-making has fairly clear benefits, evolving healthcare initiatives such as emerging technologies and reporting requirements have made it hard for providers to adopt the technique.
“Shared decision-making has not been part of providers' education,” Goldbach noted. “It's not part of the current culture. And people who practice medicine today are beset by a very busy, difficult environment where they have a lot of new requirements and a lot of new operating systems like EMRs that are distracting them. That is a difficult environment to bring in new ways of working with patients.”
Shared decision-making is also not yet reimbursed by CMS and other payers, which has seriously stalled widespread adoption, Goldbach explained. In cash-strapped practices that struggle just to meet their overhead, it is difficult to sell integrating a patient engagement overhaul. While these practices might recognize the benefits of shared decision-making, it is not an easy transition.
Industry professionals can accelerate shared decision-making adoption using either a carrot or stick approach, Goldbach noted.
“The stick is regulation, so if shared decision-making becomes a required activity people will start doing it,” Goldbach explained. “My perspective on that is provider will do it like the minimum work necessary to check that box to get paid, which is not my favorite way of seeing things happen.”
The key to making healthcare providers excited about shared decision-making is the carrot approach, or adopting shared decision-making as a quality measure. This will reinforce how shared decision-making creates value while attaching a reward for it.
“It would have a fee attached to it in some way, shape, or form, a carrot from the pay-for-performance payout,” Goldbach explained. “As population care managers, we like things that increase quality.”
Additionally, shared decision-making in value-based care can underscore the cost-cutting nature of the technique, which fills a significant vacuum in the current healthcare landscape.
The time is ripe for more widespread adoption of shared decision-making, Goldbach added. Healthcare professionals are becoming more comfortable with new technologies, and strategies have emerged to enhance, not distract from, shared decision-making.
“We do have better data on people, and we increasingly have the ability to personalize the service we give people,” Goldbach stated. “You can imagine a curated set of information and aides for patients with specific conditions easily available to them – so this kind of self-service aspect there. We see new opportunities to use technology.”
Providers have the tools to deliver educational materials that support shared decision-making to patients. DVDs, smartphone apps, websites, and links to decision aids are making education more deliverable to patients. Cross-referenced EHRs are allowing clinicians to easily prescribe these educational technologies to their patients. The entire process is more seamless, Goldbach explained.
Supporters of integrating shared decision-making into clinical care scored major support recently from the National Quality Forum (NQF). In December 2016, NQF announced standards for decision aids alongside a report about shared decision-making in healthcare.
This was a major turning point, Goldbach said, considering the reverence with which industry professionals look at NQF.
“Most of us in the industry look to the NQF as the arbiter of reasonable, real-world medical evidence,” Goldbach explained. “Not surprisingly, NQF seem to have gone through a very thoughtful process of research and are stepping along in terms of starting with their national standards for the certification of patient decision aides report in December 2016.”
NQF has established shared decision-making as a key standard of care, and also plan on publishing a playbook to support provider efforts with the technique.
“As part of that activity they were looking into the need for funding – however that may come about,” Goldbach noted. “NQF weren't prescriptive in that, but they recognize the fact that you can't expect the practice to start to take something on and not get reimbursed in some way, shape, or form for the activity.”
Shared decision-making has a considerable human component to it – educating and partnering with patients for better care is an important part of the patient experience and puts patients in control of their own health.
Currently, providers need to focus on other aspects of organizational operations instead of shared decision-making. But integrating shared decision-making into more value- and rewards-based programs can keep providers from choosing the business side of healthcare and doing right by their patients.
“You have to run a business that sustains itself,” Goldbach said. “You have to make a living. You have to satisfy quality measures. But ultimately we're there to provide care to people.”
“Providing this service is so in tune with our mission,” Goldbach concluded. “It's why we're here, but we've just got to make it possible for this to happen.”