Benefits of Engaging Patients as Partners

The Institute of Medicine recently released a report urging the health care industry to engage patients as partners in health care. The report, which grew out of the IOM’s February 2013 Roundtable on Value & Science-Driven Health Care, states that patients want to be partners in their health, and that training can help both patients and physicians engage in shared decisions.

Dave Downs, MD, heartily agrees. The former president of the Colorado Medical Society and current medical director of Engaged Public is part of a team conducting a pilot project called Engaged Benefit Design (EBD) to test the theory that when patients are more educated and involved, they make better decisions about their own health care.

“The intent is not so much to reduce cost of care as it is to improve the value of insurance benefit, so that for every dollar you put in, you’re actually purchasing more health for the population that’s insured,” Downs explains. “I think there are a lot of reasons to think that it may very well save money.”

How it works

The pilot began about 18 months ago and involves 725 covered individuals. Through the project, patients receive patient decision aids in the form of booklets or DVDs that describe the various choices the patient has for treating his or her condition. Doctors are working more closely with patients to share in the decision-making process.

For example, treatments with strong scientific evidence to support their use, such as prenatal care and insulin to treat diabetes, are called No Co-Pay, High Value, and are available at no additional cost to the patient. Other treatments that may be right for some but not for others are called Costs More, Learn More. The patient and physician may choose these treatments, but there is additional expense to the patient.

“We’ve had employees rate their view of their insurance benefits, and the response was positive — about seven out of 10 on a Likert scale,” Downs says. “We asked them the question about whether cost was a significant consideration in making their care choices, and there has been a fairly significant transition toward more cost consciousness.”

Patients and physicians agree

Downs points out that EBD does not replace the health plan selected by employers. Instead it modifies a benefit plan with the goal of improving patients’ care without raising cost. It does this by waiving co-pays for high-value services, while low-value services have a greater surcharge.

“We had worried, and a lot of employers looking at this worry about the increase in cost sharing for some services that tend to be over utilized,” Downs says. “And there was initially a little push back on the increase of co-payments, but that really has subsided.”

Downs believes the reason push back has subsided is communication, and a recognition that there are tradeoffs.

“If you say that you’re going to increase the cost of some services in order to pay for eliminating the costs of others, patients will generally get that if you put it to them properly,” he explains.

He also points out that while Engaged Public has not yet done a full assessment on provider responses to the pilot, similar pilots around the country have been received positively. Physicians say that the EBD format actually saves them time because it decompresses the time spent with patients for informational visits.

“You spend less time explaining evidence to patients and a lot more time deliberating with patients about what decision is right for them,” Downs says. “And one comment we get that I had not anticipated was that employees really like [EBD] because it felt like a reflection of their employer really caring about them.”

Next steps

Thus far the pilot has been ongoing with a large employer in the San Luis Valley in Colorado, and both parties want to see it continue. But going forward, Downs wants to see the EBD pilot expanded to reach more individuals.

“One of the single biggest issues we’ve ran into is that, with the shared decision making piece, when it’s incorporated into part of an insurance benefit, the impact is primarily just on patients that come in that have that insurance coverage,” Downs explains. “And for providers, if that represents 5% of their patient population, it’s very difficult to practice in a way where you just offer it to those patients and not to your other patients. So, going forward, we really want to look at strategies to make the shared decision making resources available more broadly.”