Making the right decisions has never been more challenging for hospitals and healthcare organizations – whether aligning care delivery with the uncertainty of reimbursements, adopting EMR platforms or purchasing the right equipment to keep up with growing patient needs. Likewise, all of us as consumers know that making the right decisions concerning our care is more complex than ever.
In this week’s blog, we’ve invited Dr. Archelle Georgiou MD, author of the new book, Healthcare Choices: 5 Steps to Getting the Medical Care You Want and Need and strategic advisor to Miga, to discuss the importance of informed decision making. We think she offers some important insights that apply to not only our healthcare experiences as consumers, but also the decisions we make every day in our professional lives.
Q. What inspired you to write Healthcare Choices?
Real people with real questions inspired me to write Healthcare Choices. Every week, I do a Facebook chat with KSTP-TV viewers who can ask me anything they want about health and healthcare. Questions include topics such as whether their symptoms are serious enough to go to the doctor, how to find the best doctor, how to select the best insurance and how to help coordinate care for an aging parent. Over the years, I’ve responded to over 1,300 people, and as I looked back at my database of questions and answers, I realized people need a lot of help finding good information, laying out their options and having the confidence to make a decision on their own. So, I decided to write a book that gives people a roadmap for making healthcare decisions that balance what they need medically with what they want personally.
Q. How can consumers take control of their healthcare and make more informed decisions?
Sixty-two percent of Americans say they want to be actively involved in their healthcare decisions by deliberating with their physician about their treatment options. Unfortunately, the majority of patients simply abdicate decision-making to their doctor with only 20 percent of patients ever raising the topic of treatment alternatives. The most common reason for patients not speaking up? A perceived “power imbalance” with their doctor as the expert. Yes, clinicians are experts in evaluating symptoms, using evidence-based information to lay out options and prescribing treatment. However, my five-step CARES Model shows consumers that they are experts of themselves and responsible for understanding, identifying and “leaning in” with their unique needs, beliefs and preferences. Together, patients and doctors are equal partners in achieving healthcare outcomes.
Q. Can you provide a more detailed explanation of the CARES Model?
CARES is the acronym for the five steps of the model:
C: Understand your CONDITION. While it may seem obvious that patients should understand their medical situation, they often overestimate what they really know. For example, in a study of patients needing a bone marrow transplant, 77 percent thought they had enough information, but when asked specific questions, only about 52 percent demonstrated knowledge of the facts. I recommend that patients ask, “so what?” – at least five times – to truly understand the implications of their condition.
A: Know your ALTERNATIVES. People expect their doctors to objectively offer all the options for their care. However, physicians have biases that can lead them to recommend one treatment over another even if alternative treatments offer the same or even better outcomes. I recommend patients ask, “what else?”
R: RESPECT your preferences. Patients’ preferences typically fit into four major categories: medical (chance of a cure or recovery versus the risk of complications or death), quality of life (level and duration of pain, dependence or inconvenience), financial (costs incurred by out-of- pocket expenses as well as time away from work), and personal (cultural and religious beliefs, fears and other sociocultural factors). I recommend that patients ask themselves “what matters most?”
E: EVALUATE your options: Patients should take time to deliberate the tradeoffs of each option and avoid the pressure of making a decision while sitting in a doctor’s office. Only patients can decide what tradeoffs they are willing to live with physically, socially and financially when faced with a medical decision. I recommend patients ask themselves, “what decision gives me peace?”
S: START taking action. Patients not only share the responsibility for decision-making, but also adhering with medications, appointments, tests, procedures, monitoring and lifestyle changes. While a common coping mechanism is to “take one day at a time,” this mindset reinforces a passive relationship with the physician and fuels a lack of accountability to the care plan. Instead, I recommend patients ask, “what next?” and establish a clear calendar of next steps.
Q. How will potential healthcare reform affect consumer decision-making?
Legislative health reform will influence the cost of health insurance, which, for some consumers, may limit the access to a range of choices for medical services. However, the CARES Model is relevant regardless of whether the nation’s healthcare system is based on the ACA or AHCA. Here’s why: No legislation will ever completely eliminate choice or access and consumers will always be faced with balancing the tradeoffs between the care they need, the care they want and the care they receive.
Q. How could the CARES model help hospitals make better decisions?
The CARES Model helps consumers make well-informed, balanced healthcare decisions. Ultimately, this results in better clinical outcomes, less decisional regret and lower cost. Hospitals can benefit from the same outcomes by applying the CARES methodology to capital equipment and purchasing decisions. For example, if a hospital is considering investing in a new MRI scanner, they will be most satisfied with their decision if they:
C: Understand the CONDITION: Define the clinical opportunity that a new scanner will address. “So what” if there is a new MRI?
A: Know the ALTERNATIVES: Identify the range of manufacturers and features that will achieve the goals. Use data to objectify the pros and cons of each option. “What else” is in the market that may meet the needs?
R: RESPECT the preferences: Clarify and balance the strategic objectives of the purchase. “What matters most” relative to cost, clinical innovation/technology and competitive positioning?
E: EVALUATE the options: Make a decision without the influence of the manufacturer’s representative. “Which decision gives us peace” if we fast forward three to five years and have to defend the purchase to our board or the community?
S: START taking action: Establish accountability. “What’s next” and what steps must the organization put in place to realize the benefits of this investment?
Learn More About Healthcare Choices
Miga continues to learn about capital equipment decision-making best practices from leading hospitals across the U.S. and the CARES model outlined above is one of the most practical approaches we’ve seen to date. If you’d like to learn more, please contact us here (https://www.migasolutions.com/enter-to-win/) to be entered into a drawing for a free autographed copy of Dr. Georgiou’s book.