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How to Build a Value-Based Patient-Provider Relationship

With risk-based programs in the works or on the horizon, providers are looking for ways to make their care pathways more valuable -- by reducing unnecessary care, while improving outcomes. This makes interactions with patients during in-person care more important -- as patient engagement and adherence after those brief face to face interactions are critical.

According to research by Emanuel & Emanuel, there are 4 styles of patient-provider relationships built around the degree of patient autonomy. Traditionally, patient-provider relationships are paternalistic, meaning the provider gives the patient instructions based on their medical knowledge and opinion, and the patient listens and generally adheres to the word of the provider. In this type of relationship, the patient has little voice or control, and the physician is seen as a guardian. Paternalistic patient-provider relationships often lead to treatment adherence, but because there is no room for patients’ personal preferences and values or ownership, patients report lower satisfaction levels with their care.

Interpretive relationships involve the physician acting as a counselor. In this type of relationship, the physician gives medical advice after exploring and taking into consideration the patient’s values. They review options with the patient based on those values and support the patient in selecting the best option for their unique situation.

Deliberative relationships are similar to interpretive relationships, in that the physician gives advice based on the values of the patient. Unlike interpretive relationships, in deliberative relationships, physicians carefully select what information to share with the patient in order to guide patients towards what the physician sees as the right treatment option.

Both Interpretive and Deliberative relationships require increased patient-provider interaction, which makes these communication styles unscalable in the current atmosphere without intervention (i.e. technology/ generated engagement). In today’s healthcare system, providers are not able to spend the necessary time with each patient to understand each individual's context and values. As a result, the responsibility is on the patient to seek out health care that aligns with their values. Healthcare companies have responded to this trend by focusing on the value they can provide to the patient, and how they can market to the patient as a consumer and healthcare as a commodity like any other.

Informative or Consumerist relationships are much more scalable. They are the opposite of paternalistic care. In this type of relationship, the provider is seen as the holder of information -- the patient decides what they will do with it. The provider informs the patient of the available options, and the consumer independently selects their choice.

These types of the relationships are experiencing a surge at the moment, which makes sense. Patients are more financially at the center of care than they have been in the past, and activated patients have better outcomes. Partnering with patients is a win-win. Providers who are moving away from paternalistic relationships, and giving their patients the tools and education they need to successfully make their own choices, are leading the pack when it comes to patient satisfaction and outcomes.

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