At the 2021 Fall Managed Care Forum, Arul Thangavel, MD, chief executive officer at WiserCare, Inc. and attending physician at the University of California, San Francisco, described the important role of shared decision-making in driving value and patient satisfaction, particularly in light of the trends in providing care virtually.
Dr. Thangavel defined shared decision-making, or SDM, as the process in which clinicians and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.
Without tailoring treatment to patient preferences, clinical outcomes are at risk, Dr. Thangavel noted. In the example of breast cancer treatment, he cited research demonstrating the discordance between patient and provider perceptions about the goals for treatment, with providers assuming that patients would prioritize avoiding mastectomy rather than a shorter duration of treatment.
SDM can be used across the spectrum of care, with all preference-sensitive decisions, including when no treatment is a viable choice. In addition to the demonstrated patient and provider benefits – ranging from improved adherence to more efficient appointments – SDM also reduces use of high-cost procedures and end-of-life care costs.
SDM was traditionally achieved through patient education brochures, telephonic outreach, and e-brochures or videos, but recent dramatic improvements in technology have enabled rapid scaling of SDM. In the digital age, Dr. Thangavel explained, practices have developed computationally driven, scalable, patient- and provider-friendly SDM interventions. These virtual-based programs also can be personalized to capture relevant patient outcomes and incorporate structured clinical data and medical evidence to guide decision-making.
He walked through an intervention for the management of knee osteoarthritis: A patient with treatment-naïve knee osteoarthritis begins conservative management, followed by a virtual re-evaluation, then an escalation to maximized conservative therapy. If the patient has not shown improvement in the subsequent virtual re-evaluation, surgery is considered, and post-operative recovery is also managed via virtual re-evaluations. Research into these programs has shown high engagement rates, with 91% of patients who began the knee osteoarthritis program completing it.
“Using new SDM programs can drive value for risk-bearing organizations,” Dr. Thangavel concluded, citing the value of programs that can be accessed across multiple channels and offer a better patient experience. With a push toward virtual care, he expects that digital SDM programs will continue to power initiatives across the care spectrum, from primary care to chronic disease management to end-of-life care.