JMIR Publications

ABSTRACT

Despite growing research demonstrating the potential for shared decision making to improve health outcomes, patient preferences – including financial trade-offs – are still not routinely incorporated into healthcare decision making. As the U.S. healthcare delivery system transitions to rewarding value-based care, the question of “value to whom?” assumes greater importance. Value-based care needs to better incorporate the patient voice into clinical decision making by normalizing shared decision making as a routine part of clinical practice. Identified as a priority by the Centers for Medicare & Medicaid Services (CMS), shared decision-making-related measures and initiatives have already been integrated into CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) demonstration projects (e.g., the Oncology Care Model and Transforming Clinical Practice Initiative) and value-based payment programs (e.g., the Merit-based Incentive Payment System, Medicare Shared Savings Program), to incentivize more proactive shared decision making engagement between patients and their providers. Furthermore, CMS has also integrated formal shared decision-making encounters into coverage and reimbursement policies (e.g., for implantable cardioverter defibrillators), demonstrating a growing interest in shared decision making and its potential for eliciting and promoting the integration of patient preferences into the clinical decision-making process. In addition to increasing policy efforts to promote shared decision making, we need more research investments aimed at understanding how to optimize the science and practice of meaningful shared decision making. The current landscape and proposed roadmap for next steps in research, outlined in this review article, will help ensure the transition of pilots and research projects regarding the implementation of shared decision making into sustainable solutions.