Transcript Shared Decision Making: Promoting patient centered care through health policy changes Karen Merrikin, JD Senior Policy Advisor Group Health Cooperative Alliance for Health Reform February 14, 2011

Shared Decision Making:
Promoting patient centered care through
health policy changes
Karen Merrikin, JD
Senior Policy Advisor
Group Health Cooperative
Alliance for Health Reform
February 14, 2011
Group Health Cooperative: Background
A member governed, non-profit health plan and care
delivery system with 650,000+ members in
Washington State and N. Idaho

Our members come to us via Medicare, employer
plans, individual plans, and low income programs.

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Two primary models of care:
Integrated Group Practice (GH owned clinics with
GH salaried providers)
Network (contracted clinics and providers)
Patient-centered care at Group Health
Implementation
timeline
2011
2009
2007
2005
Shared
electronic
medical
record
Medical
home
pilot
Decision
aids for
shared
decision
making
Evaluation
of decision aids
continues
Why Focus on This Type of Variation?
Spokane
Seattle
Community wide, variation not explained by people’s health needs or preferences.
Even within Group Health, geography is destiny
(for your knees)
22
20
18
16
Statewide Rate
2005
14
12
10
8
6
King Co
GH
Central
GH
Eastside
GH
South
Spokane
What Solutions?
For Group Health? For Communities We Serve?
34 randomized
controlled trials
7 RCTs
2 Group Health
studies
• Increased knowledge
• More active patient participation
• Better alignment between values &
choices
• Lower surgery rates
• No evidence of harms from not having
surgery
• Higher patient knowledge & satisfaction
• Lower surgery rates with similar outcomes
Health Policy Rationale for SDM Expansion
Ethical imperative - to do the right thing

Improved Informed Consent-Aligning preferences, values and lifestyle with
individual’s clinical decision
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Better Decisional Quality
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Reduced Malpractice exposure
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Bridging Health Disparities

Generally More Conservative utilization of surgical interventions

How Did We Engage our Community?
Washington State Legislation, 2007
“Just do it” – and measure results

A multi-site, coordinated demonstration project and evaluation of the
use of decision aids for elective surgeries, focused on state purchased
healthcare and coordinated through state agency.
Raise the bar on informed consent

A change in the state’s informed consent laws to recognize that
prevailing community practice patterns may not always be the “right”
benchmark when it comes to informed patient choice.
Bi-partisan Interest and Support

What’s in the Legislation:
A New Approach to Informed Consent
The Collaborative Structure & Practice Sites
Wa. State
Health Care Authority
The Everett
Clinic
Virginia Mason
Medical Center
Multicare Medical
Center
Shared Decision Making
Collaborative
Stakeholders Group
Group Health
Cooperative &
GH Research Institute
WA OFM
Puget Sound
Health Alliance
University of
Washington
Evaluation,
Coordination
SDM Collaborative: A Focus on Six Critical Areas
with High Variation in Washington State
1
Orthopedics
2
Cardiology
3
Urology
4
Women’s health
5
Breast cancer
6
Back care
Group Health’s Approach
System-wide
implementation
2-year research
project
Foundation support
12 Preference-sensitive Conditions
Orthopedics
Cardiology
1. Hip
osteoarthritis
2. Knee
osteoarthritis
3. Coronary
artery
disease
Women’s
Health
Breast
Cancer
6. Uterine
fibroids
7. Abnormal
uterine
bleeding
8. Early stage
9. Ductal
carcinoma
in situ
10. Breast
reconstruction
Urology
4. Benign
prostatic
hyperplasia
5. Prostate
cancer
Back Care
11. Spinal
stenosis
12. Herniated
disc
Distributing Decision Aids
DVDs can be
ordered for
mailing or
viewed on the
Web
What are We Learning?
Ordering & viewing
Provider interviews
Patient survey
link
Decision aid distribution
Number of videos
distributed, by month
Total: 8,808*
*As of 12/31/2010;
does not include decision
aids viewed on the web
after Oct 2009
Jan
2009
Apr
Jul
Oct
Jan
2010
Apr
Jul
Oct
Fewer missed opportunities
Percentage of procedures for preference sensitive conditions
where patient did not receive the video
2009
2010
Patient assessment
Overall rating of decision aid videos
Patient survey, September2010, 950 responses
Helped you understand
the treatment choices
Helped you prepare to
talk with provider
Patient assessment
Overall rating of decision aid videos
Patient survey, September 2010, 975 responses
How important is it that providers make
programs like this available?
Next Steps at Group Health
Preliminary findings from Group Health’s 2 year evaluation, likely
complete in late Spring, 2011.

Patient

satisfaction, cost impact, strategies to improve usage rates.
However, Group Health is not waiting for the formal results.
We are accelerating our efforts to implement SDM, focusing on ways to
incorporate shared decisionmaking into standard workflows, and
broadening adoption among our network providers.

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We now measure “defect rate” around SDM.
Where Must We Go From Here?
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National Certification Standards and Processes for Decision Aids
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
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Assures Decision Aids are High Quality, Unbiased, Up to date.
Activates Informed Consent Law Provisions.
Policy Strategies that Promote Widespread Adoption
Payment,

Patient and Purchaser Demand
CMS
& Employers
Satisfied

certification, collaboratives, measurement
Patients
“Authorized AND Appropriated”
So, Why Shared Decision Making?
Because we care about better value
Because care should be centered around
patient’s values.
And because we can take our experience in
working collaboratively on SDM and apply it
to broader health reform challenges.