Advancing Shared Decision Making
The Informed Medical Decisions Foundation, now a division of Healthwise, has been working to advance evidence-based shared decision making since 1989. We believe the only way to ensure that high quality health care decisions are being made is for a fully informed patient to participate in a shared decision making process with their clinician. Through our research and advocacy efforts, we are dedicated to helping people make better health decisions.
The beginning of February sees us 10 months into the merger between Healthwise and the Informed Medical Decisions Foundation, and much has happened in that time to advance the cause of ensuring that more and more people are informed and involved in their health care decisions. For those not in the know, Healthwise focuses on developing health education solutions for providers and payers, while the Foundation retains its emphasis on research and advocacy to amplify the patient’s voice in health care. The two organizations are united by our common mission to help people make better health decisions.
Colleagues in both Boston and Boise have been planning our next-generation suite of patient decision aids tailored to both the complexity of the decision and the needs of the person facing it. At the same time, our unified group of medical editors—who have one foot in the clinician world and one foot in the research world—have been reviewing and bringing their expertise to bear on the current, extensive set of decision aids that are already available from Healthwise. A number of these programs are scheduled for 2015 enhancements to increase their value to patients and clients even further.
Patient-facing decision support tools are an important way to make shared decision making (SDM) practical in the busy world of medicine. However, nothing would be more tragic than an informed patient who wants to be involved in a decision hitting a “brick wall” when visiting a clinician. In 2014, we developed the SDM Skills Course to help clinicians improve the shared-decision-making conversation, with or without the use of decision aids. A pilot program at Group Health yielded very positive reviews and ideas for improvement that have already been incorporated. A series of implementations is planned for 2015!
On the policy front, a historic event occurred when the Center for Medicare and Medicaid Services (CMS) issued a proposed decision memo for lung cancer screening with low-dose computed tomography. The memo proposes “…that the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low dose computed tomography (LDCT), once per year, as an additional preventive service benefit under the Medicare program…” provided that clinical, and presumably, patient preference criteria are met. Healthwise submitted comments, and we look forward to a final coverage decision. Many clinicians note that ordering an expensive or risky test or treatment takes less time and pays better than talking to patients about whether they may or may not want the intervention. The precedent of CMS reimbursing clinicians for their time in having those discussions is an important development indeed!
On the research front, the Foundation collaborated with a number of Healthwise medical editors and demonstration site investigators on major research grants that were submitted in 2014 to funding agencies including the NIH, AHRQ, and PCORI. Kenrik Duru, Carol Mangione, Mike Pignone, Steve Atlas, David Arterburn, and LJ Fagnan were among our collaborators. As favorable priority scores are now rolling in, we anticipate many if not most of these projects will be funded and initiated in 2015!
Finally, we were excited to learn in December that Washington State was awarded a 4-year, $65 million Center for Medicare and Medicaid Innovation grant for its “Healthier Washington” plan. Healthwise will collaborate with the state’s Health Care Authority to provide assistance in implementing SDM in the state, starting with decision support for pregnant women, along with a state certification program for decision aids. We hope other states will soon follow suit!
I look forward to seeing these developments flourish in 2015, and I wish you all a happy, healthy, and productive year!
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