Shared Decision Making, reducing the cost of care through innovation

Study demonstrates how Shared Decision Making-based health coaching dramatically reduces the overall costs of care, hospitalizations, and surgeries

Health Dialog today announced that results from its recent study on Shared Decision Making have been included in the Healthcare Leadership Council's (HLC) 'The Future is Here: A Compendium of Healthcare Innovation' as one example of a health improvement concept that is making a positive impact on transforming today's healthcare system. 

The document can be downloaded by visiting the HLC's website at http://www.hlc.org/TheFutureIsHere.

'Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference Sensitive Conditions', authored by David Veroff, senior vice president of innovation at Health Dialog, compared the effects on patients engaging in key health and treatment decisions receiving a usual level of support with the effects of receiving enhanced levels of support. The study, published in the 2013 February issue of Health Affairs, shows that compared with patients who received the usual level of support, patients who received enhanced support had:

• 5.3% lower medical costs (including 8.7% lower costs for those with heart conditions);
• 12.5% fewer hospital admissions; and
• 9.9% fewer preference-sensitive surgeries (including 20.9% fewer preference-sensitive heart surgeries)

"Health Dialog is demonstrating how improving the decision making process between physicians and patients can improve health and curb costs," said Mary R. Grealy, president of the Healthcare Leadership Council. "What Health Dialog is achieving exemplifies the message of this compendium, that today's healthcare leaders are successfully shaping a 21^st century system that keeps people healthy, improves patient outcomes, maintains affordability and combats the escalation in chronic disease."

Embedding shared decision making in primary care

Sharing decision making with the patient benefits individuals and the NHS as a whole

Making shared decision making a reality can be acheived if it is streamlined into routine NHS processes. Photograph: 3M

Overview

"No decision about me, without me" is the fundamental principle underpinning many of the current changes in NHS healthcare. Healthcare professionals may fail to recognise how knowledgeable patients are, or to understand the beliefs of individuals and groups. By engaging in balanced discourse, clinicians not only help a person come to terms with their needs and the potential gains and losses from different treatment approaches, but also broaden their own understanding of what is important to people.

The principle of engaged patients being well informed and taking a central role in all decisions made in their care is neither new nor revolutionary, but some patients may be passive receivers of care and many medical professionals, inadvertently or otherwise, are paternalistic in their delivery. Sharing decision making with the patient, referenced to understandable evidence and timely support when selecting investigation and treatment options, benefits not only individuals but the system as a whole.

Project Aims and Methods

Making shared decision making (SDM) a reality for patients can only be achieved if it is systematically streamlined into routine NHS processes, steering clear of lengthy bureaucracy. Nationally, a number of tools have been produced which now need to be rolled out locally and regionally. In order to support this work in the south of England, a 'community of interest' has been established to enable interested clinicians, who want to know more, to access training, ideas and peer support to try things out in their own clinical context.

Activities in the community of interest include a focus on integrating shared decision making so it becomes an integral part of the patient pathway and clinical behaviours. As well as embedding shared decision making from the provider perspective, SDM needs integrating into policies, commissioning systems and consent procedures. A particular focus therefore for the community of interest is to provide information, insight and advice about how clinical commissioning groups (CCGs) can deliver on their statutory duties, including practical tools and processes, and indicators of what "good commissioning of shared decision making would look like" at CCG level. A range of different activities have been delivered since the community was established, utilising new technologies to spread the word through different channels.

Findings

Twenty-two clinical commissioning groups across the south of England responded to an initial survey. Ninety-five per cent of respondents asked for more information or support on shared decision making. Fifty-six per cent of respondents definitely understood what SDM is trying to achieve and 63% indicated that SDM featured in their CCG plan. In relation to CCG plans, 45% included SDM in planned care (specifically MSK) and 35% in relation to long-term conditions. Fieldwork indicates that, in reality, CCGs are at very varied stages in their development which can be categorised as:

• Interested in SDM and currently developing an understanding of how to implement in practice
• Interested and with some engagement to introducing SDM in an identified clinical area
• Have a full SDM plan with internal accountability for delivery

The implications for the community of interest are to develop a wider suite of options to address the variability in practice. Regular WebEx updates from practitioners, tailored visits and expert mentorship to support specific initiatives, and the development of materials for patients and clinicians, are all part of the range of offerings needed to move individual CCGs on from their various starting points.

Recommendations

The wider implication for policy from the work carried out in the South of England is that more time and resource needs to be given to supporting the CCG community with practical help for implementation.

This includes developing an evidence base of the impact on patients of the use of patient decision aids and option grids, as well as assessing the impact on patient satisfaction of commissioning changes. Peer learning and clinical engagement are critical to embedding deep change in relation to shared decision making.

Working with Thames Valley HIEC

This project was carried out by the knowledge team, with project support from Pfizer Ltd and funding from NHS South of England and Pfizer Ltd. Pfizer are supporting the project as part of their commitment to work together for Britain's national health through partnership.

We can help you by:

• Involving you in the Community of Interest for shared decision making in the south of England
• Advising you on the appropriate level of support to help you meet your current CCG aims for SDM
• Signposting you to the national tools and approaches.

Thames Valley Health Knowledge Team

Contact: Email: knowledgeteam@tvhiec.org.uk

http://www.theguardian.com/healthcare-network/healthcare-innovation-partner-zone/shared-decision-making-primary-care

Health Literacy Could Reduce Medicare Expenses

By Clara Ritger | Friday, September 13, 2013 | 1:09 p.m.Photo: AP Photo/Anja Niedringhaus

Patients – particularly minorities and those on Medicare – are not actively making decisions about their treatments and procedures because doctor-patient communication is poor, according to a study presented Thursday to MedPAC, the Congressional advisory committee on Medicare.

The result is a greater expense for Medicare and a lack of empowerment among patients.

"Once patients understand the risks and benefits of expensive procedures, they tend to opt for more conservative treatment options," said Rita Redberg, a MedPAC member and professor at the University of California San Francisco School of Medicine.

It's the reason physicians and hospitals are resisting training programs that would teach care providers to include patients in the decision-making process, Redberg said, because they lose money when patients choose less-costly options.

The deliberations of the 17 MedPAC members will be presented as recommendations to Congress and the Department of Health and Human Services.

Improving health literacy, or the ability of patients to understand their health care and make informed decisions, is a stated priority for HHS Secretary Kathleen Sebelius.

It's a priority that could come with significant financial implications for the United States. In 2007, a team of researchers estimated that low health literacy costs the U.S. between $106 and $236 billion annually. A number of factors account for those costs, including a patient's inability to find the best provider, treatment and services for his or her condition. The researchers argue the savings would be enough to insure all of the more than 47 million patients who were uninsured in the U.S. in 2006.

There's room to grow – only 22 percent of Americans are reported to be "proficient" when it comes to their understanding of health care costs and services, according to a U.S. Department of Education study.

Low-income adults are disporportionally affected. Health literacy was lower on average for adults living below the poverty level than those living above, the DOE's 2003 National Assessment of Adult Literacy found. As income increased, so did health literacy.

Racial and ethnic minorities had lower average health literacy scores than White adults, the study showed. Forty-one percent of Hispanic adults and 24 percent of Black adults had below basic levels of health literacy, compared with 9 percent of White adults.

Those numbers complement MedPAC's findings that Hispanic and Black patients report poorer communication with providers than Whites and the 2012 National Healthcare Disparities Report which found that Hispanic and Black patients were less likely to be asked their preferences in treatment decisions.

The health literacy problem also poses a challenge for the success of the Affordable Care Act. Once the exchanges open on Oct. 1, the millions of new patients added to the system in the coming years are expected to have high rates of health illiteracy, as many of them may not have had health insurance before.

How to inform patients – and who to hold accountable for health information – remains controversial. Some MedPAC members argued that health literacy wasn't only the responsibility of the patient, but also the provider, to explain health options in ways patients can understand.

"What if patients were treated with dignity and respect?" said George Miller, a MedPAC member and CEO of CommUnityCare in Austin, Tex. "Maybe then they'd feel empowered."

The consensus among the group was that patient engagement was an important issue that needs to be addressed, but they were unsure how Medicare would play a role.

"Health literacy is a responsibility of the Medicare program in that we should be paying for care that supports shared decision-making," said Mary Naylor, MedPAC member and a professor at the University of Pennsylvania School of Nursing.

But that, commission members said, leaves the question of how MedPAC would measure success, and providing financial incentives for patient-inclusion appeared contentious.

The commission will wrap up its meeting Friday at the Ronald Reagan Building, International Trade Center in the Horizon Ballroom.

http://mobile.nationaljournal.com/congress/health-literacy-could-reduce-medicare-expenses-20130913