How shared decision-making can advance patient engagement

An initiative between Beth Israel Lahey Health and the Massachusetts Blues plan showed increased rates of colorectal cancer screenings.

Shared decision-making can get providers, payers and patients can get everyone on the same page for medical care choices.

When patients, providers and payers work hand-in-hand to collaborate on treatment and care decisions, positive patient outcomes are more likely to ensue.

However, this type of partnership – also known as shared decision-making – is more rare than it seems. For example, a late 2022 American Hospital Association survey found that 78 percent of hospitals and health systems said their relationship with commercial insurers is getting worse. Fewer than 1 percent said their relationships with payers was improving.

One notable exception to this trend is a collaboration forged in 2021 between Beth Israel Lahey Health and Blue Cross Blue Shield of Massachusetts – in this instance, the payer and provider worked together through shared decision-making with patients for a program that improved patients’ overall colorectal cancer screening rates.

Why shared decision-making?

While shared decision-making is not a new concept in healthcare, it is a key component of patient-centered healthcare, according to Often in healthcare, there is no single “right” decision because all choices involving medical tests, treatments and health issues come with pros and cons.

Shared decision-making is particularly valuable in these three instances:

  • • When there is more than one reasonable option, such as for screening or a treatment decision.
  • • When no one option has a clear advantage.
  • • When the possible benefits and harms of each option affect patients differently. 

Health information technology tools, such as interactive decision aids, patient portals, electronic health records and secure text messaging, have an important role to play in shared decision-making. For patients, shared decision-making offers numerous benefits, including greater knowledge and understanding of their health status and treatment options, better preparation for dialogue with providers, and deeper understanding of the rewards and risks associated with various options.

Why pick colorectal cancer screening?

When leaders from Beth Israel Lahey Health (BILH) and Blue Cross Blue Shield of Massachusetts (BCBSMA) explored options for improving patient care through shared decision-making, colorectal cancer screening quickly emerged as the best test case.

While some may believe that a colonoscopy is the only screening option for colorectal cancer, in reality there are several options – and ultimately the best option for the patient is the test that gets performed. Early screening and detection of colorectal cancer improves the likelihood of positive outcomes by enabling patients who are found to have the condition to begin receiving treatment sooner.

The first step for the collaborative project was to identify patients who were the appropriate demographic to receive a colorectal cancer screening. A feasibility analysis was performed through a shared population health platform leading the organizations to identify two groups of patients to target for the colorectal cancer screening program – patients between the ages of 45 and 49 who were new to the screening process, and older patients who were not engaging in screenings ahead of their primary care appointments.

After consulting with physicians and researchers, BILH and BCBSMA developed an easy-to-understand decision-aid tool, a PDF document that contained evidence-based information about the different colorectal cancer screen options that could be shared with patients to involve them in their screening decision.

The decision-aid tool was sent via text message before patients’ meetings with their providers, to promote discussion during their appointments. To further increase patient engagement and promote greater health equity, the text messages went out in English, Spanish and Portuguese.

The results

BILH and BCBSMA identified and sent text messages to 17,000 patients who were identified for the program, with 13,000 of the messages successfully delivered to eligible patients. The program drove a 10 percent increase in screening completion after the beginning of the text messaging campaign. Additionally, the percentage of patients who elected to be screened via at-home tests grew to 20 percent from 5 percent.

Further, physicians found that the program helped them reduce the backlog of patients seeking colonoscopies after the pandemic. Primary care physicians who worried that the added conversation would negatively impact their schedules, reported that, in practice, the short conversation did not affect them significantly and will ultimately reduce further conversations after patients have a colorectal cancer screening plan in place.

One key challenge associated with text messaging was patient age. For example, patients who were 49 to 59 years old were highly likely to receive the message on their mobile phones, but messages sent to patients between the ages of 60 and 75 often went to a landline that could not receive the message. The two organizations are continuing to explore workarounds for this situation because it is ideal for patients to receive the information and digest it ahead of their appointments.

Through partnerships like BILH and BCBSMA’s colorectal cancer screening campaign, shared decision-making programs are likely to grow throughout healthcare in the coming years. Technology that enables healthcare organizations to identify, target and reach the right patients is essential to ensuring these programs improve patient engagement.

Nina Zelcer is a senior manager at Arcadia, a population health management and health intelligence platform.

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