What better way to improve upon your health condition than to actively participate in it yourself? This logic is one in which the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) use in their partnered quest to find ways to improve healthcare while reducing costs. Patient engagement is a potentially powerful tool for enhancing the quality of healthcare in a way that is satisfying to all parties involved. When patients actively engage in their own well-being, i.e. through education and understanding, they are more willing to comply with medical instruction. This makes the job of the healthcare provider easier and can reduce unnecessary costs for the healthcare system. The overall effect can also impact patient satisfaction, increase patient motivation to actively maintain their health, and continue the cycle of health maintenance.
Here are three ways in which CMS, AHRQ, and others are using policy and program to initiate and motivate patients to take on a more active role in the decisions and actions that influence their own health outcomes.
Shared Decision Making (SDM) Model
CMS, in collaboration with AHRQ, have revealed two different care delivery models that aim to increase patient engagement by encouraging patients to participate to a greater extent in the decision-making aspect of their health care. This includes greater access to health information that would enable them to make informed health decisions. In the Shared Decision Making (SDM) Model, healthcare providers who participate in an Accountable Care Organization (ACO) or the Medicare Shared Savings Plan (MSSP) work together with their patients to decide upon treatment options for the following six health conditions: stable ischemic heart disease, hip osteoarthritis, knee osteoarthritis, herniated disk or spinal stenosis, clinically localized prostate cancer, and benign prostate hyperplasia. The plan revolves around four steps: 1) identifying appropriate SDM patients, 2) distributing patient decision aids (PDAs) to them, 3) discussing treatment options, making a decision, and documenting it, and 4) tracking and reporting the whole process. By integrating this process into standard clinical practice, this provides patients with the tools needed to better understand their condition, empowers them to make informed decisions that align with their own preferences and values, and allows them to collaborate with their physician to come up with the best treatment choice for their particular situation. The patient-physician relationship is also improved; patients trust that their physician respects them and has their best interests in mind, and patient compliance during the treatment is improved because of this trust and because they themselves helped to decide on the path of treatment.
Direct Decision Support (DDS) Model
Another model of patient engagement, the Direct Decision Support (DDS) Model, is similar to the SDM model in that it focuses on engaging patients who have the same six medical conditions specified above. However, in this model, the point of patient engagement begins outside of the clinical care setting. Decision Support Organizations (DSOs), which are assigned to populations within specific geographical regions, provide support and relevant information to patients about available treatment options. Patients are given various patient-friendly educational tools to increase their knowledge of their condition (i.e. web-based PDAs, telephone support, mobile e-health applications) and DSOs are there to provide decision support to better-informed patients. The role of the DSO, however, is not meant to replace important physician advice, but rather to enhance the patient-physician relationship by arming patients with the knowledge that can lead to better discussions regarding their own care.
Another strategy for patient engagement is the the teach-back method. Healthcare providers educate patients on what they need to know about their specific condition and how to maintain or improve it. Patients are then required to repeat back to the healthcare professional what they learned and remembered. If the information is incorrect, the healthcare provider explains the information again and rechecks the patient’s understanding with another round of repetition. By encouraging patients to explain crucial information or instructions in their own words, the technique helps to reassure physicians that patients have a clear understanding of their condition and what they need to do about it. The method helps patients to feel more confident in their ability to manage their condition and can lead to increased motivation to comply with treatment plans.