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Historically, SDM was offered to a patient facing a preference-sensitive condition for which more than one effective treatment exists. Examples include knee and hip osteoarthritis and back pain.

However, as evidence continues to accrue on the effectiveness of SDM to deliver better outcomes, fewer invasive procedures, and lower costs, many are advocating for broader — even routine — use of SDM across primary care and myriad of specialty areas including orthopedics, cardiology as well as treatment for breast cancer.

SDM is successful because it enhances the traditional doctor-patient paradigm. Too often patients are reluctant to share their concerns with their physicians. All too often they make healthcare decisions without completely understanding all their treatment options.

SDM offers patients new tools, which provide evidence-based, unbiased information on treatment options and condition management to support a more informed physician-patient discussion.

Quality decision aids are third-party reviewed, provide information that is easy to understand and available in multiple formats (web, DVDs and booklets) and feature real patients explaining how and why they made their treatment decisions. The result: patients who are more informed and better engaged in their health care decisions.

Better engagement, improved outcomes, lower costs… and did we say happier members?

The success of shared decision making is no secret. A February 2017 Wall Street Journal article summarized nearly two decades of data validating SDM as a health care approach that “leads to better outcomes, fewer invasive procedures and lower costs.”

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The article highlights a 2013 Health study which found “patients who were encouraged by health coaches to review options and get more involved in choices had 5.3 percent lower overall medical costs, 12.5 percent fewer hospital admissions and fewer elective surgeries.”

Perhaps most importantly, patients like SDM: data show those who use SDM tools report being more satisfied with both their care and their health plan. As plan sponsors seeks strategies for improving member engagement in wellness activities and portals, SDM presents a time-tested tool for attracting members, which supports the overall success of population health programs.

Quality matters

Many of the nation’s leading medical organizations support the use of SDM, including the Institute of Medicine, U.S. Preventative Services Task Force and the American Medical Association. They concur, quality matters.

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Not all decision aids reflect the level of quality required to facilitate the enviable benefits SDM can deliver. In one instance, a provider group thought they were “practicing SDM” by sending a postcard in advance of a doctor visit. This will not drive the level of patient involvement that can impact your wellness or population health program.

Several initiatives are underway that underscore the importance of quality SDM tools. These provide useful guidelines for selecting a quality tool.

In 2005, the International Patient Decision Aid Standards Collaboration (IPDAS) — a group of global researchers, clinicians, and stakeholders — established internationally approved standards to assess the quality of patient decision aids. The IPDAS checklist includes criteria on whether the decision aid:

• Includes information about options in sufficient detail for decision making

• Presents probabilities of outcomes in an unbiased and understandable way

• Provides methods for clarifying and expressing patients’ values

• Includes structured guidance in deliberation and communication

• Presents information in a balanced manner

• Was developed through a systematic development process

• Uses up to date scientific evidence that is cited or referenced

• Discloses conflicts of interest

• Presents information in plain language

In 2016, the state of Washington became the first state to formally review, certify and advocate the use of high-quality decision aids. SDM is “a key component of the Healthier Washington initiative,” and state leaders hope the certification process will become a model for other states. California, Connecticut, Maine, Minnesota and Vermont have also passed legislation on SDM with more states sure to follow.

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In January 2017, the National Quality Forum — a nonprofit organization that promotes and ensures patient protections and healthcare quality through measurement and public reporting — issued a set of national standards to validate the quality of decision aids.

NQF also established a panel focused on advancing shared decision making between patients and providers and promoting SDM as a standard of care.

In April 2017, the National Committee for Quality Assurance (NCQA) announced plans to revise its health plan accreditation standards. The proposed revisions would require members to make decision aids available to patients, and cite 10 studies that found decision aids improve patients’ knowledge and understanding of their condition and of the treatment options and outcome probabilities. NCQA will finalize its 2018 standards in July.

Effective decision aids should reflect historic as well as emerging quality standards, and these decision aids exist today. They should present benefits and risks of treatment options in easy-to-understand language and visuals. They should also be routinely reviewed and updated by a group of qualified physicians to ensure they reflect the most current clinical evidence.

SDM: The time is now

Shared decision making is the cornerstone of patient-centric care. It’s a time-tested, patient-beloved tool that offers unprecedented opportunity to engage employees on a better path to good health. Better engagement leads to better health outcomes; healthier people equal lower costs. Choose carefully because quality matters.

However, guidelines exist that can help you make the choice that will support your program’s success. Quality SDM is fast becoming a vital part of many wellness and population health programs with far-reaching benefits for all stakeholders — employees, employers and insurance companies. A few health portals now offer access to quality tools. If your company or insurance plan doesn’t offer SDM, the time is now.