Use Shared Decision Making to Maximize Health Insurance Benefits

Depression and Bipolar Support Alliance for Care for Your Mind

It’s no secret that out-of-pocket healthcare costs—the amount you pay—have risen significantly. These expenses have been trending upward for over a decade and there is no indication that this trend will end anytime soon. In 2013, according to the HealthAffairs Blog, nearly one-third of participants in an employer-sponsored plan had a high deductible. Plans purchased through the federal marketplace have similar out-of-pocket costs, especially at the Bronze level.

The rationale behind Health Savings Accounts (tax-free accounts where money is set aside for medical expenses) is that, when people have a financial investment in their healthcare, they are more likely to make better decisions about how they consume or use this commodity. It’s fair to say that this idea can also support the trend towards higher copays or co-insurance.

Are these trends discriminatory towards individuals and families with chronic diseases or disorders? According to the Peterson-Kaiser Health System Tracker, 30% of adults with a mental health condition are not receiving care, with cost being a major factor. A Kaiser Family Foundation Tracking Poll revealed that 25% of Americans reported that someone in their home had been diagnosed with a mental health condition, but that one in five did not receive care. Of those, 13% indicated that they could not afford care and 12% reported that their insurance plan would not cover it.

All of these trends make it increasingly important that individuals receiving mental health care make the best use of time spent with their mental health care providers. Working with a team that embraces shared decision making is a good place to start. When the mental health care team has a clear understanding of the outcomes and goals that are important to the individual receiving care, the potential to shorten the process towards wellness increases and funds expended on mental health care can decrease.

Own your wellness plan
One tool that can help you identify outcomes that are important to you and can assist you in staying on-course is a wellness plan. When used in collaboration with your mental health care team, it can assist them in developing a more personal and individualized treatment plan.

Dr. Gregory Simon, Psychiatrist and Researcher at Group Health Cooperative in Seattle, shares that “creating and updating a personal wellness plan can help you to work more effectively with your doctor or therapist. Your plan will help you clarify and communicate what matters most to you: your goals for treatment, your progress towards those goals, and how well different treatments (medications and psychotherapy) are helping you.”

The Depression and Bipolar Support Alliance (DBSA) has an easy-to-use plan that can be accessed from its Facing Us web page. This site requires you to create a password, allowing you to develop your own personal plan with the assurance that no one else can access or see its content. You may also consider developing the plan in collaboration with your mental health care team. This helps them engage in shared decision making from the very start.

The plan contains multiple categories or steps, “puts you in control of your own wellness, and gives you a clear picture of what you’re working for every day.” The DBSA Wellness Plan has seven steps:

Step 1: Defining My Wellness Goals. Setting personal wellness goals is central to recovery. The site contains boxes to enter both big goals and small steps towards achieving these goals. Sharing them with your mental health care team enables them to design a treatment plan that will help you get there.

Step 2: Identifying Daily Self-Care Action Steps. These are things you try to do to keep yourself on track (for example, going to bed by 10:30 each night or taking a walk every day). Keeping a journal of these activities and sharing it with your mental health care team offers them insights into what is important to you and how to tailor your treatment so that you can perform your self-care tasks.

Step 3: Setting Up a Support Network. In this section you can write down the names of, and contact information for, reliable people who can “be there for you.” You may wish to also include your mental health care team as part of that network.

Step 4: Watching for Warning Signs. You are the best indicator of how you are doing. Being able to identify when things are getting off track assists your care team in making adjustments to your treatment plan.

Step 5: Managing Triggers: Identifying triggers can make sessions with your mental health care team more productive. If you know what the triggers are, you can work with them to mitigate their effect should they occur, and even work on ways to change your environment to avoid them in the first place.

Step 6: Creating a Booster Plan. Share with your mental health care team a list of specific things you can do when you’re having trouble. By knowing what helps you, they are in a position to tell you about other resources or tools that you may not know about.

Step 7: Creating a Crisis Management Plan. Even people who invest in their own self-care can hit a road bump. Having a crisis management plan in place ahead of time allows your mental health care team to provide the care that you and the team have decided will work best for you.

Shared decision making helps people achieve quality lives of wellness because everyone is working toward the same goals as identified by the individual. But that potential is most fully recognized through ongoing mutual collaboration between the individual and the care team. Your health is not static, nor is your treatment plan. Both are always evolving. Dr. Simon, who also serves as the DBSA Scientific Advisory Board Chair, offers this advice: “Don’t be shy about bringing your plan with you to every visit.”

You don’t have to be great to start …… you have to start to be great!! (User tip from FacingUs.org)

Your Turn

  • How has sharing a wellness plan with your mental health care team improved collaboration or shared decision making between you and your mental health care team?
  • If you have not yet tried this approach, in what ways do you think shared decision making would (or would not) be helpful?

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