Incentivizing shared decision making in the USA--where are we now?

Area of Science:

• Health Policy
• Health Services Research
• Patient Engagement

Background:

• The Affordable Care Act (ACA) spurred interest in shared decision making (SDM) and patient decision aids (PDAs).
• Key challenges include practical implementation of incentives and effective measurement of SDM and PDA utilization.
• This review examines developments and proposals related to these challenges.

Purpose of the Study:

• To review current developments and proposals regarding the implementation and measurement of shared decision making (SDM) and patient decision aids (PDAs) under the Affordable Care Act (ACA).
• To identify challenges in incentivizing and assessing the utilization of SDM and PDAs.

Main Methods:

• A qualitative document analysis was conducted.
• A pragmatic search of databases (Medline, Google Scholar, etc.) and LexisNexis was performed from 2009-2013.
• Keywords included "Affordable Care Act," "Shared Decision Making," "measurement," and "incentives."

Main Results:

• Significant lack of clarity exists on how to measure shared decision making (SDM) and effectively incentivize patient decision aid (PDA) use.
• Many documents equate PDA dissemination with SDM, despite limited evidence of impact on patient-provider communication.
• Assessing SDM for performance management remains a significant challenge.

Conclusions:

• Incentive efforts for shared decision making (SDM) may overemphasize patient decision aids (PDAs).
• This focus risks neglecting the opportunity to improve patient-provider communication processes.
• Effective measurement and practical implementation strategies for SDM are crucial.