In Reply Dr Alper and colleagues voice their endorsement of our recommendations to focus health financing on health and to measure what matters most to people. They go on to propose that payers reimburse for “shared decision making and clinical decision support,” believing it could “change health care.” Although it is appealing to look for other alternatives to the current transactional reimbursement system, substituting one process (shared decision making) for another (visits) as a trigger for payment may not ultimately achieve the true outcomes that matter most to individuals, such as achieving improved functional status, extending meaningful longevity, alleviating pain, or slowing the onset of dementia. There may be local priorities that have huge effects on a community’s health—safe housing in one neighborhood, more accessible education in another, and walking trails in a third. Key to improving the health and well-being of individuals and communities is understanding the true barriers to healthy behaviors. Measuring what matters to people, rather than paying for specific processes, will promote locally inspired innovation that improves outcomes.
Tang PC, Smith MD. Prioritizing Shared Decision Making—Reply. JAMA. 2017;317(8):857. doi:10.1001/jama.2016.21145