How a Payer-Provider Partnership Supported Share Decision-Making

The problem of tackling cancer screening gaps post-pandemic isn’t exactly an original story. Most payers and their provider partners faced this issue after COVID-19 pushed many to delay preventive care.

But a unique partnership between Blue Cross Blue Shield of Massachusetts and Lahey Beth Israel Health that focused on shared decision-making might provide a novel approach to patient engagement.

In a recent program from the two long-time payer-provider partners, BCBSMA and BILH were able to provide patient education and counseling to folks who were due for a colorectal cancer screening.

Colorectal cancer screenings—or any preventive screening, really—took a hit during the COVID-19 pandemic. At the pandemic’s outset, most provider organizations had to shut down non-emergency healthcare access, including screenings. According to one assessment, cancer screening rates tanked by 80 percent between March and April of 2020.

It’s taken a Herculean effort to get patients back in for care and see those cancer screening rates rebound to pre-pandemic levels.

Payers and providers were both concerned with getting folks in for preventive screenings, but because they both take care of members and patients differently, their messaging can often get mixed up.

That’s not to mention the documented hurdles both payers and providers report when working with each other. A November 2022 survey from the American Hospital Association found that 78 percent of hospitals think it’s getting harder to work with the payers with which they’re contracted.

But that wasn’t the case for BCBSMA when it worked with BILH on a shared decision-making program tailored for increasing colorectal cancer screening rates. According to Laura Carr, PharmD, the director of provider performance at Blue Cross MA, embarking on the patient engagement program made good sense after building a good rapport with BILH for a few years.

“They've been a great partner on many initiatives to improve quality and the efficiency of patient care,” Carr said in a phone call with PatientEngagementHIT.

So when BCBSMA approached BILH with a plan to formalize shared decision-making in patient engagement, the partnership seemed natural.

First, the pair looked at how best to implement shared decision-making. While the practice—which essentially tasks the provider with outlining different care options for patients and working together to identify the best solution—is good for all kinds of care, there are some areas where it’s more applicable.

Particularly, Carr said the organizations wanted to tailor shared decision-making to colorectal cancer screening because there are multiple different ways a patient can get that done: fecal occult blood test, sigmoidoscopy, colonoscopy, virtual colonoscopy, or DNA stool test. Each type of screening has different benefits or risks, plus different price points, so Carr said it was a prime use case for shared decision-making.

From there, the payer and provider had to determine how best to streamline patient education. After all, making sure the patient truly understands every option is central to shared decision-making. Without that patient education, the patient does not have all of the information to participate in decision-making.

Using a patient education tool as a decision aid was crucial to making sure patients understood their options without adding burden to busy clinician workflows.

“It makes it much easier on the provider when there's high quality education tools that help to educate the patient on the options, their individual risk, potential risks and benefits to the population and to the patient,” Carr explained.

BILH created a tool that it could share with patients before a healthcare visit, but Carr added that it was important not to only rely on that level of pre-visit engagement.

“The tool is also dynamic, so a provider can also pull the tool up in the visit and walk through with the patient quickly and efficiently and hit all the key points that are important for the patient to make the decision and be informed,” she noted.

The patient education tool was also translated into multiple languages and included a vast amount of information about each of the screening options so as not to sway patient decisions a certain way, Carr added.

All said, BILH and BCBSMA were able to identify and contact 17,000 people via text message who were a good fit for the shared decision-making program. Of those messages, 13,000 were delivered to eligible patients, and they made a sizeable impact, Carr reported.

Between January and September 2022, the number of colorectal cancer screenings that happened rose by 10 percent. That was a big help in getting the organizations back to pre-pandemic cancer screening rates.

What’s more, it helped patients pick more effective methods of colorectal cancer screening. Particularly, the number of patients electing at-home tests, which tend to be less invasive and a better fit for low-risk patients, went from 5 percent to 20 percent.

But perhaps most notable was the way the program impacted the providers working at BILH.

“The providers felt that it did help with decision-making. It did help patients consider more than one option for colorectal cancer screening, and it didn't really add much time,” Carr said. “That's something that's always been a hesitation when these models. People see this big form and think it's going to be a 10-minute conversation with patients, and providers found that it was an effective and efficient way to communicate with their patients.”

Carr added that it was important for BCBSMA and BILH to have a collaborative relationship while developing and implementing the shared decision-making program. As part of her role, Carr meets with contracted providers like BILH to make sure they are supported during these clinical quality improvement initiatives.

“We help to make sure that they have data that is not only plentiful but also actionable and that really highlights areas of opportunity that also make sense with their organization,” she noted. “And so we learn where their priorities are, where some of their barriers are, and collaborate on how to resolve them together.”

She also facilitates peer-to-peer collaboration and meetings among multiple different provider organizations contracted with BCBSMA. This helps the organizations to share strategies and best practices, Carr noted.

In terms of the shared decision-making program, Carr noted it has the potential to support better patient engagement—and adherence to best practices—in multiple different clinical states.

“We really do think that shared decision-making allows for patient-centered care that improves patient outcomes and patient experience, and it really empowers patients to make informed decisions with their providers,” Carr concluded. “It's an area that we hope to continue to partner with more provider organizations and expand to more clinical areas in the future.”