Provider versus Payer Centric Shared Decision Making Support: There's A Big Difference

By Bob Tavares

In its post “What Can A Hockey Game Tell Us About Shared Decision Making?”, the Disease Management Care Blog may have missed the important difference between physician-centric versus payer-centric models for patient decision support. While efforts to support shared decision making (SDM) have largely been driven by payers in the past, it is now possible for physicians to “prescribe” patient decision aids and track patient compliance directly from their electronic health record.

This brings up three important questions:

1) Can traditional disease management firms re-invent themselves to support provider groups (including Accountable Care Organizations) as they assume more risk? If the answer is “yes,” that will probably mean moving from 30 mega payer contracts to 300 small provider contracts - just to keep revenue flat with smaller margins.

2) Can providers who want to build shared decision making themselves really cobble together all of the pieces? The most advanced medical homes have EMRs, registries, and patient portals but many are still very crude as it relates to population health management (PHM).

3) Will a new class of population health management (PHM) firm emerge that doesn't have the baggage of the legacy firms? That's my bet. There are new PHM companies that have traditional disease management execs at the helm who are building a provider centric solution from the ground up. Business rules are being built to ensure that every patient is connected to the appropriate level of decision support across the continuum of care.

My company is working with over 100 hospitals, many of whom are embracing SDM and positioning themselves to be ACOs. We have a long way to go before SDM becomes the standard of care, but providers are further along than you may think. We estimate we’ll be providing decision support programs to approximately 1 million patients this year.