How Shared Decision-Making, Patient Decision Aids Impact Cost, Utilization

Associated with improved patient satisfaction and quality of care, shared decision-making (SDM), which is the process by which clinicians work with patients to explore care choices, and patient decision aids (PtDAs), the evidence-based tools designed to educate patients about their options, have garnered conflicting data regarding their impact on cost and utilization.

Panelists of a session presented this week at the Pharmacy Quality Alliance (PQA) 2021 Annual Meeting noted that SDM and PtDAs’ influence on medication adherence may signal beneficial cost implications from these patient-centered strategies.

“Stakeholders often assume that engaging in SDM will reduce health care costs, which is the third part of the Triple Aim” said panelist Kimberly Westrich, vice president of Health Services Research at the National Pharmaceutical Council (NPC). “They think it might do this by empowering patients to make treatment decisions that reduce unnecessary, invasive, or costly care, but the actual impacts of SDM and PtDAs on cost and utilization have not been well studied.”

During the session, “The Impact of Shared Decision-Making on Cost and Utilization and Implications for Value-Based Care,” Westrich was also joined by panelist Theresa Schmidt, vice president at Discern Health. Both panelists’ respective organizations are seeking to further explore whether SDM and PtDAs reduce health care costs and utilization.

NPC and Discern Health conducted a systematic review of 51 articles derived from PubMed between January 1, 2010 and September 30, 2019 that met criteria of involving SDM (n = 15), PtDA (n = 25), or both interventions (n = 11), with 1 of 3 outcome measures prioritized:

• outcomes pertaining to dollar amounts such as total cost of care and component costs
• utilization of resource-intensive services (cardiac screening, surgery, clinical visit)
• prevention-related care (cancer screening, nutritional support, appropriate screening)

“The articles in our results covered diverse demographics of population sizes, racial or ethnic groups, genders and ages,” explained Schmidt. “The interventions were also implemented in a number of therapeutic areas and settings, the most common clinical area we observed was cancer screenings–other common areas included cardiovascular conditions, orthopedics, and mental health.”

Of the articles assessed, 31 reported at least 1 outcome that was identified as being favorable, with decreased costs (n = 5), decreased utilization (n = 14), and increases in prevention-related care (n =20) also found. Conversely, 3 articles indicated increased utilization and 2 reported a decrease in prevention-related care.

“While the majority of the articles did present favorable results, a greater majority, 39 out of 51, indicated at least one relevant outcome where no significant difference was observed,” added Schmidt.

Speaking on these mixed findings, Westrich highlighted how SDM and PtDA do not always lead to reduced health care costs or utilization, “but in the value-based care context, including incentives for SDM around treatment options could still result in a net positive, even if the benefits or savings do not occur within a narrow payment window.”

“This is because SDM and PtDAs promote decisions that are concordant with patient care and increase patient engagement in their care, which can have a positive impact on outcomes such as medication adherence,” said Westrich.

In fact, improvements in medication adherence were reported in 9 of the 12 articles that assessed for the topic. As some patients report the benefit of SDM and PtDA on medication adherence, Schmidt said that this can lead to better treatment outcomes, fewer adverse events, and also long-term savings.

Although SDM and PtDA may not prove to have a direct effect on reducing health care costs with benefits varying by patient, including these interventions and value-based payment programs can advance other parts of the Triple Aim in improving experience of care and the health of populations, noted Westrich.