Shared decisions save costs

Shared decision making with patient and health-coach involvement saves on overall costs of care. Specifically, the technique reduces hospitalizations and surgeries, according to a study published in Health Affairs (February 2013).

Patients with enhanced support demonstrated 5.3% lower costs than patients without it. Cost reductions were attributed to 12.5% fewer hospital admissions and 9.9% fewer preference-sensitive surgeries, including heart surgery.

“The savings were more than four times the costs for these services,” says study author David Veroff, senior vice president of innovation for Health Dialog, which provided the coaching services for the study. “While the more than $23 per-member per-month in savings required actively supporting many patients, the program is cost efficient because it is delivered remotely using health coaches with clinical training who are centrally located. This approach yields tremendous economies of scale and allows consistency of highly effective service that patients love.”

Health coaches provided engagement by phone and with printed decision-aid materials and videos for patient review. Veroff says higher risk patients were engaged in active outreach, and were identified through proprietary claims-based risk models.

 “What’s interesting is that the trial itself was set up to assess whether extending services beyond the very highest risk patients would produce positive results, Veroff says. “It is quite evident from these results that the short answer is ‘yes.’” 

A subset of the total population had back pain, knee pain, hip pain, cardiac conditions, benign uterine conditions and benign prostatic conditions and interacted with a health coach. Such conditions typically offer multiple treatment options. More than 22% of the at-risk people in the enhanced-support group interacted with a health coach, compared to fewer than 8% in the usual-support group, according to the study.

He says payers and providers need adequate information about patients to assess risks and how they can be supported. Increasingly, providers are interested in on-site decision making models, he says, however, providers perceive time and lack of systems as the biggest constraints to offering patients such services.

“Furthermore, the financial incentives to perform shared decision making are minimal,” Veroff says.

The Patient Protection and Affordable Care Act calls for such models in the Medicare Shared Savings and Pioneer Accountable Care Organization programs. While pilot programs are in place in a few areas, payers historically have not provided physicians direct incentives for the services.