Brian Wu, PhD
Essential Insights contributor, healthcare writer
The shift in attitude of what defines a patient-provider relationship is another key driver of the patient empowerment movement.
Donald Berwick, former president of the Institute for Healthcare Improvement and administrator of the Centers for Medicare & Medicaid Services, wrote in the Journal of the American Medical Association (JAMA), that healthcare delivery can be divided into three eras. The first was the era of the "noble doctor" who was a trusted source of information and whose orders were not questioned by the patient. The second era-our current one-is largely centered on accountability and measurement. Berwick now calls for the healthcare system to move toward a third era, which would focus on principles of cooperation (particularly cooperation between doctor and patient) and prevention.
Corbin Shaw, another healthcare innovation specialist at Fuse, has also seen a fundamental change in the broader patient-provider relationship, including doctors, nurses, pharmacists and others delivering care. "The key to empowering patients is to engage patients. Patients are now viewed as valuable members of the care team and their engagement is critical in creating a comprehensive care plan," Shaw said. "It must be said, though, that in order to achieve this engagement and empowerment, good communication and rapport must be built with providers, who still need to take time to make sure patients are making truly informed healthcare decisions."
According to Dr. James Weinstein and his fellow authors in a Health Affairs article, current thinking supports replacing informed consent with the informed choice process. This process should include:
The authors advocate for shared decision making using decision aids.
Objective, credible data and decision support tools can equip hospitals and providers to lead the informed choice process, according to Brian Fuller, vice president of value-based care for naviHealth, a Cardinal Health company. naviHealth offers decision support tools to help identify, predict and optimize an appropriate, customized, patient-centered care plan for patients, particularly those facing transitions in care or post-acute care.
Cardinal Health Chief Medical Officer Shaden Marzouk said Berwick's third era is becoming a reality, noting that "Paradigms are shifting to more coordination of care, and cost constraints are forcing multiple disciplines to work together for a patient."
Cost constraints are also prompting more patients to become increasingly active in making healthcare decisions for themselves and their family members. "Patients know these decisions impact both their physical and financial health," Redgrave added.
Dr. Marzouk says these financial pressures are causing stakeholders to look at other sites for delivering more cost-effective, convenient care. "The rise of urgent care centers, clinics in pharmacies, and retail clinics are all examples of consumer-driven healthcare choices," Marzouk said. "I see a continued shift toward more easily-accessible sites like one's phone, storefront locations, and pharmacies that could be more affordable for patients."
Patients may now have more interest in controlling their healthcare costs, as more Americans have been moved into consumer-driven health plans with higher deductibles by their employers, who are searching for ways to control their health benefit expenses.
There is a growing awareness that patients who are educated and empowered to make sound healthcare decisions tend to have better outcomes, which can save money, particularly in the management of chronic diseases. In their full article , Dr. Weinstein and his fellow authors emphasize that research has shown that informed, empowered decisions can increase patient comprehension of benefits and risks of options, foster realistic expectations, decrease conflict and indecision, increase patient participation, and lead to decisions that help to reconcile patient values and choices.
It's clear that the rise of digital health, a changing attitude about the role of the patient, and cost constraints are all contributing to a new era in healthcare, where decisions will be driven by a collaborative relationship between empowered patients and their healthcare providers.