Why Shared Decision-Making Tools Should Include Price Transparency

Shared decision-making tools that also integrate information about healthcare costs both help support patient empowerment and help patients manage their medical expenses, according to a new FAIR Health report.

The report, which looked at senior patient and caregiver experiences with FAIR Health’s own shared decision-making aids, also showed that the digital divide, limited health literacy, and short appointment times get in the way of meaningfully using decision aids.

Shared decision-making refers to the collaboration between patients, their caregivers, and their providers in deciding to conduct a test or begin a certain treatment regimen. Providers who practice shared decision-making will outline a patient’s disease state, the patient’s options, and the potential outcomes of different treatment plans.

For their part, patients are in charge of outlining their personal quality-of-life goals and priorities, using the information presented by providers to guide their ultimate care decision.

But shared decision-making needs to account for more than just clinical outcomes, a conceit that is the premise of this FAIR Health report.

“Although older adults shoulder a significant portion of healthcare costs, they do not always get the care that they prefer,” the report authors said.

Moreover, the report authors noted that price transparency can be elusive, and it makes it hard for patients to make a wholly informed decision about their treatment.

“Shared decision making shows promise for engaging older patients and their caregivers/care partners in healthcare decisions and reducing unnecessary spending and healthcare costs,” the report authors said.

FAIR Health developed a suite of shared decision-making aids that combine clinical information with cost information from FAIR’s private claims database. Packaged in the FAIR Health Consumer website, these shared decision-making aids were made available for download as part of a nationwide program. The consumer website had a provider complement, the report noted.

That program, which touched more than 10,000 older adults over age 65 and their family caregivers and care partners and found that, ultimately, these tools were helpful. The FAIR Health Consumer website got 9,700 unique users and the provider website had 612 unique users.

The data showed that both patients and providers alike wanted to engage with the tools available; while the consumer website had 3,640 decision toolkit downloads, the provider one had 484 downloads.

What’s more, patients and their caregivers liked the tools.

Three-quarters of program participants said the decision aids were useful or very useful, while 67 percent said the tools helped them understand shared decision-making. The information about healthcare costs was particularly useful for 65 percent of program participants.

In the qualitative feedback portion of the program, patients and caregivers emphasized the power that shared decision-making tools had in supporting patient empowerment.

“It’s very promising because it really gives them decision-making capability so they can compare and know what they’re going to be paying out of pocket, how much money they’re going to spend, and whether it’s something that they need to do to invest money in,” one program participant said.

Having that cost information is essential, the report furthered, considering the level of frustrating patients and caregivers had with healthcare price transparency. That frustration is not unfounded, as healthcare organizations fall short on federal mandates for healthcare price transparency.

Despite the promise of the decision aids, the report authors noted some barriers patients still had to shared decision-making. For one, they don’t have enough time to discuss these materials with their providers. Appointments are short, so it’s hard to cover everything patients want to discuss to fully engage in shared decision-making.

Patients and providers are on the same page about shared decision-making, with providers telling the researchers they are excited to incorporate more shared decision-making into the exam room.

“Despite the time constraints, most providers who were interviewed believed that they could incorporate elements of the tools during their visits with patients,” the report authors said. “During discussions, they expressed their eagerness to promote awareness of the tools and brainstormed various methods, which included incorporating links to the tools and information into patients’ electronic health records and creating a curriculum centered on shared decision making for healthcare providers, students and fellows.”

Limited patient health literacy and patient access to digital devices upon which health information is offered likewise stand in the way, the researchers said.

Still, promoting awareness about shared decision-making, particularly among patients and caregivers, may help ease some of these challenges, the researchers offered.

“The successful dissemination and outreach campaign implemented during the grant provided FAIR Health with a road map upon which it will further develop best practices that will be leveraged for future shared decision making initiatives,” they concluded. “Long term, these program findings, coupled with ongoing dissemination, may also encourage policy discussions among relevant and engaged stakeholders regarding the broader dissemination of shared decision making in diverse settings.”