Read the New England Journal of Medicine article: Shared Decision Making to Improve Care and Reduce Costs
Washington, D.C. — The Affordable Care Act gives the department of Health and Human Services the authority to implement an important provision designed to improve patient care and reduce health care costs, according to a new Center for American Progress article published today in the New England Journal of Medicine. Authored by CAP Senior Fellow Ezekiel Emanuel and health policy expert Emily Oshima Lee, the journal article details an approach known as “shared decision making”—a collaborative process between patients and their physicians—and provides recommendations to kick start the implementation of this strategy to improve patient care.
Making complex medical decisions, for which there is more than one course of treatment, can be overwhelming and challenging for patients and their families. Shared decision making uses patient decision aids to help patients better understand their treatment options and decide which treatment option best aligns with their preferences and values. Decision aids are meant to be evidence-based and inform patients about the risks and benefits of tests and treatments, their relative effectiveness, and their costs. Patient decision aids can include fact sheets and questionnaires, interactive online tools, videos, and discussion guides for doctors to use in conversations with patients. These aids can be used by the patient before an office visit, or can be used jointly by the provider and patient during an appointment.
“Shared decision making is the ideal government program to implement and implement rapidly. It improves the quality of care by increasing patient understanding and engagement to ensure care matches patients’ values and it reduces costs. All the data—and there are many well-conducted studies—show decision aids reduce use of services 10 percent to 20 percent and increase patient satisfaction,” said Dr. Ezekiel Emanuel, co-author of the article and Senior Fellow at the Center for American Progress.
Although numerous studies show that using patient decision aids can provide a number of benefits—including patients feeling more comfortable with their care decisions, reduced use of invasive treatment options without detracting from health outcomes, and lower costs of care—shared decision making is not widely used by physicians. A provision in the Affordable Care Act calls for greater use of shared decision making by requiring the secretary of health and human services to work with organizations to develop standards for patient decision aids and to certify aids that meet these standards. Additionally, the Affordable Care Act allows the Center for Medicare and Medicaid Innovation to test payment models that reimburse Medicare providers for using patient decision aids. However, the department has not yet implemented these provisions.
In order to spur action around the implementation of patient decision aids, Emanuel and Oshima Lee detail the following recommendations in their article:
- The Department of Health and Human Services should quickly launch pilot programs for shared decision making while working to standardize and certify decision aids.
- Medicare should require the use of decision aids for the 20 most frequently performed procedures, with full reimbursement contingent on documented use of shared decision making. Many decision aids have already been rigorously evaluated, so the Centers for Medicare & Medicaid Services could rapidly certify these tools and require their use in the Medicare and Medicaid programs.
- The improved quality of care and savings gained through shared decision making should be maximized by integrating this approach into other Affordable Care Act initiatives. The documented use of patient decision aids, for example, could be used as a quality metric in patient-centered medical homes, accountable care organizations, and systems caring for patients eligible for both Medicare and Medicaid.
Read the New England Journal of Medicine article: Shared Decision Making to Improve Care and Reduce Costs by Emily Oshima Lee and Ezekiel Emanuel
Related resources from the Center for American Progress:
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