Commonwealth Fund Research on Shared Decision Making Tools

When patients are given decision aids, such as educational booklets, DVDs, or interactive tools, to help them make treatment choices, they are more knowledgeable and satisfied with their care. But the use of such aids as part of "shared decision making"—a communication approach that seeks to balance clinicians' expertise with patients' preferences—has until recently been limited to research trials. Now some health systems and public policymakers are supporting more widespread use of shared decision making in efforts to promote patient engagement, reduce inappropriate use, and control costs.

The latest issue of Quality Matters from the Commonwealth Fund examines a recent national IOM survey of adults facing a medical decision—to take a new medication, have elective surgery, or undergo a cancer screening—in which patients overwhelmingly said they wanted to learn about the risks associated with various treatment options and have their providers listen to them. But less than half of patients reported that their provider asked them about their goals and concerns for treatment.

To address this problem, some private payers and public policymakers, as well as some health care systems, are encouraging the practice of shared decision making, which involves not just a physician recommending a course of action, or a patient left on their own to make a choice, but rather both parties working together to balance clinicians' experience and expertise with patients' preferences and values. Decision aids such as educational literature, videos, or Web-based tools are designed to help patients prepare for these conversations by weighing the potential benefits, risks, and uncertainties of a medical procedure.

As we work to implement more value-based purchasing strategies, shared decision making can play an important role in changing the physician-patient relationship to work toward providing more patient-centered care.

Institute of Medicine Report on Health Care Transformation

America's health care system has become too complex and costly to continue business as usual, says a new report from the Institute of Medicine. Inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness, the report says. However, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at lower cost, added the committee that wrote the report.

The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. The committee calculated that about 30 percent of health spending in 2009 -- roughly $750 billion -- was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.

Incremental upgrades and changes by individual hospitals or providers will not suffice, the committee said. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health system into a "learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery. It will necessitate embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners, and establishing greater teamwork and transparency within health care organizations. Also, incentives and payment systems should emphasize the value and outcomes of care.

IOM Report Release: Best Care at Lower Cost

On Thursday, September 6, the Institute of Medicine will be releasing a new report from The Learning Health Care System in America project. Describing the path to continuously learning health care, Best Care at Lower Cost explores the innovative opportunities to use emerging technology and science to address one of the nation's most fundamental challenges: getting better value from our health care. Working against the backdrop of a compelling and rapidly growing urgency, the report identifies three major imperatives for a change in approach: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. But the report also points out that emerging tools like computing power, connectivity, team-based care, and systems engineering techniques—tools that were previously unavailable—make the envisioned transition possible, and are already being put to successful use in pioneering health care organizations. Applying these new strategies can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost. The report’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation.

You are invited to participate via the live webcast.

IOM panel: Insurance exchanges will fail unless cost factor is faced

A report for the Dept. of Health of Human Services notes that greater use of standardized, evidence-based medicine could reduce health spending.

Federal officials must balance cost and comprehensiveness when crafting the minimum benefits package required for health insurance exchange plans, according to an advisory group. Otherwise, these coverage expansions in the health system reform law will fall short. Read the full article...

Essential Health Benefits: Balancing Costs, Coverage, And Necessity

The much anticipated Institute of Medicine Report on essential health benefits (EHB) was released last week with a series of recommendations that answered some questions and raised many more. The report offers a very important opportunity for researchers, policymakers, providers and patients to fill in some of the white space between the recommendations. Read on for the full post...

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