karen merrikin, jd senior policy advisor group health cooperative shared decision making: promoting...
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Karen Merrikin, JD
Senior Policy Advisor
Group Health Cooperative
Shared Decision Making: Promoting patient centered care through health policy changes
Alliance for Health Reform
February 14, 2011
Group Health Cooperative: Background
A member governed, non-profit health plan and care delivery system with 650,000+ members in Washington State and N. Idaho
Our members come to us via Medicare, employer plans, individual plans, and low income programs.
Two primary models of care:
Integrated Group Practice (GH owned clinics with GH salaried providers)
Network (contracted clinics and providers)
Patient-centered care at Group Health
Shared electronic medical record
Medical home pilot
Decision aids for shared decision making
20052005
20072007
20092009
Implementationtimeline 20112011
Evaluation of decision aids continues
Why Focus on This Type of Variation?
Spokane
Seattle
Community wide, variation not explained by people’s health needs or preferences.
Even within Group Health, geography is destiny (for your knees)
6
8
10
12
14
16
18
20
22
King Co GHCentral
GHEastside
GHSouth
Spokane
Statewide Rate2005
What Solutions? For Group Health? For Communities We Serve?
Health Policy Rationale for SDM Expansion
Ethical imperative - to do the right thing
Improved Informed Consent-Aligning preferences, values and lifestyle with individual’s clinical decision
Better Decisional Quality
Reduced Malpractice exposure
Bridging Health Disparities
Generally More Conservative utilization of surgical interventions
How Did We Engage our Community?Washington State Legislation, 2007
“Just do it” – and measure results
A multi-site, coordinated demonstration project and evaluation of the use of decision aids for elective surgeries, focused on state purchased healthcare and coordinated through state agency.
Raise the bar on informed consent
A change in the state’s informed consent laws to recognize that prevailing community practice patterns may not always be the “right” benchmark when it comes to informed patient choice.
Bi-partisan Interest and Support
What’s in the Legislation: A New Approach to Informed Consent
Wa. StateHealth Care Authority
Shared Decision MakingCollaborative
Stakeholders Group
Group HealthCooperative &GH Research Institute
The Everett Clinic
Puget Sound Health Alliance
Virginia MasonMedical Center University of
WashingtonEvaluation,
Coordination
WA OFM
The Collaborative Structure & Practice Sites
Multicare Medical Center
SDM Collaborative: A Focus on Six Critical Areas with High Variation in Washington State
1
2
3
4
5
6
Group Health’s Approach
System-wide implementation
2-year research project
Foundation support
12 Preference-sensitive Conditions
1. Hip osteoarthritis
2. Knee osteoarthritis
3. Coronary artery disease
4. Benign prostatic hyperplasia
5. Prostate cancer
6. Uterine fibroids
7. Abnormal uterine bleeding
8. Early stage9. Ductal
carcinoma in situ
10. Breast reconstruction
11. Spinal stenosis
12. Herniated disc
Distributing Decision Aids
DVDs can be ordered for
mailing or viewed on the
Web
What are We Learning?
Decision aid distribution
Number of videos distributed, by month Total: 8,808*
*As of 12/31/2010; does not include decision aids viewed on the web after Oct 2009
Jan Apr Jul Oct Jan Apr Jul Oct2009 2010
2009 2010
Percentage of procedures for preference sensitive conditions where patient did not receive the video
Fewer missed opportunities
Overall rating of decision aid videosPatient survey, September2010, 950 responses
Helped you understand the treatment choices
Helped you prepare to talk with provider
Patient assessment
Patient assessment
Overall rating of decision aid videosPatient survey, September 2010, 975 responses
How important is it that providers make programs like this available?
Next Steps at Group Health
Preliminary findings from Group Health’s 2 year evaluation, likely complete in late Spring, 2011.
Patient satisfaction, cost impact, strategies to improve usage rates.
However, Group Health is not waiting for the formal results.
We are accelerating our efforts to implement SDM, focusing on ways to incorporate shared decisionmaking into standard workflows, and broadening adoption among our network providers.
We now measure “defect rate” around SDM.
Where Must We Go From Here?
National Certification Standards and Processes for Decision Aids
Assures Decision Aids are High Quality, Unbiased, Up to date. Activates Informed Consent Law Provisions.
Policy Strategies that Promote Widespread Adoption
Payment, certification, collaboratives, measurement
Patient and Purchaser Demand
CMS & Employers
Satisfied Patients
“Authorized AND Appropriated”
So, Why Shared Decision Making?
Because we care about better value
Because care should be centered around patient’s values.
And because we can take our experience in working collaboratively on SDM and apply it to broader health reform challenges.
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