The Journal of the American Medical Association (JAMA) published an article in the April 4, 2017 issue entitled, “Prime Time for Shared Decision Making,” that looks at how informed patients often choose more conservative and less expensive medical options.
“The recognition that informed patients often choose more conservative and hence less expensive medical options has made Shared Decision Making a focus of value-based care.”
This statement has important implications for employee benefits professionals because it states that patients (i.e. employees and their families) are often NOT adequately informed about the medical decisions made for them. If they were, they would choose LESS care and LESS expensive care.
What is Shared Decision Making?
Shared decision making is a process conducted by a clinician and a patient, who has a condition that has more than one clinically appropriate intervention or management strategy (such as stable ischemic heart disease or herniated disc) and helps the patient decide among multiple acceptable healthcare choices.
In layman’s terms: When your healthcare provider and you decide TOGETHER which treatment is best for your condition.
Heart disease or a herniated disc are two examples of conditions that have more than one clinically appropriate treatment. However, there are MANY conditions that have more than one clinically appropriate intervention, including whether or not to have:
- Antibiotics for an upper respiratory tract infection
- An MRI for back, knee or hip pain
- Spine surgery
- $3,000 per month Humira vs. $40 per month Methotrexate for rheumatoid arthritis
- Chemotherapy for advanced- or late-stage cancer
- Cardiac stress test
- Whole body CT scan for an Executive Physical
- Upper endoscopy (EGD) for heartburn symptoms
- Robot-assisted surgery
Surprisingly, only Washington State has legislation that mandates that healthcare providers engage in shared decision making with their patients. In a small sample of 15 hospitals, 14 of them had very basic patient education processes. Their version of patient education includes pamphlets that advise on things like ”what clothing to wear for procedures.” In other words, 14 out of the 15 hospitals did not use any tools for doctors and patients to use in shared decision making.
Takeaways for Employee Benefits Professionals
- Your plan members are having tests, procedures and medications prescribed to them WITHOUT a full discussion of MULTIPLE ACCEPTABLE healthcare choices.
- More importantly, your plan is PAYING for these tests, procedures and medications without plan members having a full discussion of acceptable healthcare choices.
The most practical way employee benefits professionals can promote shared decision making is to encourage second opinions among their employees and plan members.#Employeebenefits professionals - promote shared decision making to your plan members. Click To Tweet
Healthcare is often subjective and physician opinions will often differ from one to another. If it were my own family or my own employees, I would encourage them to get a second opinion before having a significant test, procedure or medication in a non-emergency situation.