Charlie Keller, a primary care physician at Mercy Clinics, Inc. describes Mercy's experience with shared decision making implementation.
This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.
Innovative Implementation of Shared Medical Decision Making in a Clinic-based ACO
1. INNOVATIVE
IMPLEMENTATION OF
SHARED MEDICAL DECISION
MAKING IN A CLINIC-BASED
ACO
Shared Decision Making in the Real World:
Stories from the Frontline
March 6, 2013 Webinar
Thank you for allowing me the opportunity to present at this webinar. It is an honor to help kick off Shared Decision Making Month with the Foundation.
I am a new addition to a long-standing team here at Mercy Des Moines. In the interest of full disclosure I will say that our Shared Decision Making project is funded by the Informed Medical Decisions Foundation. I truly appreciate their support and collaboration.
A little bit about Mercy Clinics in the Des Moines area.
The reality we all face is that health care financing is uncertain and changing as we speak. I think Shared Decision Making in particular enhances our response to the areas in red. INTERESTINGLY: just 2 days ago there was new report from the National Commission on Physician Payment Reform that listed as the first recommendation as the elimination of nearly all fee-for-service payment schemes in healthcare, as well as focusing on quality and value.
Why did we start on this path to utilizing Shared Decision Aids?
First step was developing a Medical Home Model: Mercy started down this path some time ago, and as you will see this early work has paid off in implementing the SDM project. We started small using pilot projects, which then spread throughout the system based on those successes
What helped Mercy was to have a mission and a vision – this provided the roadmap and helped to focus the projects. Much of the success Mercy has had is thanks to the hard work over many years of the people on the second slide as well as many others in the individual clinics.
Health Coaches are the people who really make all this work for us. They are the linchpin of our operation. These are special people in a special role.
Briefly – this is the charge of each Health Coach, and as you shall see, Shared Decision Making fits nicely into these functions.
What do our Health Coaches hear from patients? Some quotes: Thank you for making me accountable for my health. You have no idea how much you have changed my life. Thank you for taking time to make me understand my diabetes and how it affects my body. You saved my life. You have been my coach, my mentor, my friend, and will always remain so. So, From this day forward, success with integrity, abundance with wisdom, honor with character, health and healing, fullness of joy, never ending peace, long life with satisfaction, and laughter be upon you and your household all the days of your life.
Briefly, what were the aims of our project?
Based on those aims, we focused on Osteoarthritis of the Hip and Knee, Acute and Chronic Low Back Pain, Colon Cancer Screening, and 2 different Advanced Directives Programs.
Well, what do our patients think of the Shared Decision Aids? I think you can see that they think they are very valuable to helping them make the best decision for their condition.
Briefly, let me give you 3 examples of how this has worked in my practice. These are but 3 examples of patients who have very different goals, values, and problems who have been helped by the unbiased and patient oriented materials provided.
If you haven’t seen it, there was a wonderful article in Health Affairs last month on the implementation of Shared Decision Aids in Primary Care Clinics. A few key findings…
So, what was it that has allowed Mercy to be successful thus far? As you’ll see, the previous groundwork with our Health Coaches and the Medical Home approach helped tremendously. It provided both a top down and a bottom up approach. This gave it the support of key movers within the organization, as well as people on the front lines.
It is really pretty organic, and while we have a basic structure in place, the teams are allowed to explore what will be successful in their clinic and share it with others.
Health Coaches are acting in concert with the Physician Champions, who volunteered to work on this project.
What have we specifically experienced, some of which is noted in HA article.My experience has been that the handoff is key, and despite physician concerns about the time it may take, it usually only takes a few minutes to introduce the concept, discuss the Shared Decision Aid, and get the Health Coach involved to ensure appropriate documentation and follow-up.
We have found several keys to utilizing the Shared Decision Aids. As stated before, the warm handoff seems to be a key ingredient for success. Sometimes this involves the Health Coaches handing off tasks to the physician by identifying appropriate patients via pre-visit chart reviews. Sometimes it is the opposite with the physician handing off to the Health Coach when they identify an appropriate patient. Ideally everyone who has patient contact would be aware of the project and help identify appropriate patients.
Bottom line – we at Mercy have seen that we can make changes in an uncertain environment that profit our physicians and system right now.
We feel strongly that Shared Decision Making is the next emerging trend in patient centered care.WE WANT TO BE THERE FIRST.