In Healthcare Reform, Helping Patients Pick the Right Doctor Is Key to Accountable Care

In Healthcare Reform, Helping Patients Pick the Right Doctor Is Key to Accountable Care

PLAINSBORO, N.J. — How do patients pick their doctors? When a patient needs a specialist, is taking a referral from their family physician always the best route? Not always, according to Brian W. Powers and Sachin H. Jain, MD, MBA, Lecturer in Health Care Policy, Harvard Medical School. They present a new framework for patient-centered physician selection in the current issue of Evidence-Based Oncology, a publication of The American Journal of Managed Care.

Historic approaches to physician selections overlook a growing understanding of patient priorities when selecting a physician, the authors write, particularly when it is essential to match the doctor’s therapeutic approach with the patient’s values, which can arise in cancer care.

“Instead our prevailing approaches to matching patients with physicians remain largely agnostic to variations in patient preferences, tethered to the traditions of peer recommendation and reputation-based referral,” they write. Recent changes to a more consumer-drive approach still focus heavily on cost and outcomes and overlook other criteria, they say.

Powers and Jain outline a five areas of the patient-physician relationship that should be evaluated when patients are selecting a doctor:

• Communications and decision-making. This is the “anchor” of the relationship, and patient preferences vary widely.
• Therapeutic approach. For “preference-sensitive” conditions, physician intensity varies. The authors write that these are precisely the areas for which patients spend the most time selecting a good match. A doctor’s willingness to use complementary or alternative therapies should be considered.
• Social and cultural appropriateness. Cultural, religious and other preferences must be considered, along with fluency in a patient’s preferred language.
• Cost and value. What patients will pay out-of-pocket has to be discussed upfront and is a key variable.
• Practice environment. How long is the wait in the office? Does the practice use electronic health records, and has this been adequately explained? How good is coordination of care? These issues are key to patients with complex illnesses.

A patient-centered selection model starts with the recognition that not every doctor is right for every patient. Giving patients access to data to select doctors who are right for them is essential, the authors write.

“True patient-centeredness will only emerge when we acknowledge this reality and build the tools, systems, and strategies to understand and manage this heterogeneity,” they write. “Fortunately, there has been a dramatic influx in the availability of the data needed to populate the various components of this framework.”

About the Journal

The American Journal of Managed Care, now in its 20^th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the AJMC family of publications are The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision makers with information to improve the efficiency and health outcomes in managing pharmaceutical care. In December 2013, AJMC introduced The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, and immunology and infectious disease. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

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