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CMS grant designed to boost patient-physician shared decision-making

The $36 million contribution shows the federal agency’s interest in a movement to get patients more engaged in their treatment decisions.

By — Posted July 3, 2012

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A coalition of large, integrated health systems has won $36.1 million in grant funding to help implement shared decision-making by hiring staff tasked with “activating” patients and their families to be part of care and treatment decisions.

The funding for the High Value Health Care Collaborative is part of a $1 billion Innovation Grant program from the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation. The HVHCC is led by scholars at Dartmouth College and Dartmouth-Hitchcock Health System and is made up of 15 large health systems, including Mayo Clinic, Scott & White Healthcare and Beth Israel Deaconess Medical Center.

The health systems will use the grant money primarily to hire and train an estimated 48 patient and family activators over three years to help with shared decision-making related to hip, knee or spine surgery, and for patients with diabetes or congestive heart failure. The goal is to save $64 million by avoiding unnecessary care.

William Weeks, MD, medical director of the HVHCC, said shared decision-making leads to more informed choices and has been shown to save money by reducing utilization while improving patients’ experiences. It has its roots in the tradition of primary care and the one-on-one conversation with a physician, but more formal shared decision-making includes the use of decision-making tools like videos, counseling by medical and social services staff, and outcomes measurement.

Dr. Weeks said it would be difficult for a physician practice to pay for a patient and family activator as the HVHCC members have modeled it. Physicians can adopt shared decision-making in a less financially demanding way than hiring “patient and family activators” for their practices, said Peter Goldbach, MD, chief medical officer for Health Dialog. The Boston-based firm sells patient decision-making aids to health plans, hospitals and physician practices. The educational material they offer is online and on video and is meant to help patients understand the relative risks and benefits of a treatment.

Health Dialog has worked with the Informed Medical Decisions Foundation, another source of funding for Dartmouth’s work around shared decision-making. Dr. Goldbach said the smaller practices funded by the foundation have had less than uniform success compared with the larger institutions adopting a formal shared decision-making program, but researchers are trying to get a better understanding of what works for smaller practices. (See correction)

No matter what the setting, Dr. Goldbach said, physicians are crucial to patients making informed decisions — and that doesn’t always mean a long conversation, or series of conversations. It can be a matter of a physician “prescribing” a video for a patient deciding whether or not to get knee surgery.

“If a physician prescribes it, engagement is way higher,” he said.

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