In 2013, the American Academy of Optometry accepted a lecture proposal that I had submitted for several years, and invited me to present an Ellerbrock continuing education session on shared decision making (SDM) at our annual meeting. It was the first time SDM received a national platform in optometry – and I thank the Academy to this day for recognizing its importance. I continue to study SDM, its benefits, and emerging impacts. Integration of SDM into patient care continues to progress. SDM is defined as a “collaborative process that allows patients and their providers to make health care decisions together’; SDM incorporates “the best clinical evidence available, as well as the patient’s values and preferences.” SDM improves the quality of care and has also been shown to reduce health care costs. Lots has happened since that time, including recent efforts to develop new incentives through new Medicare models for providers to build the use of decision aids – tools that facilitate shared decision making in clinical practice – into routine care. Efforts so far have primarily focused on decision making in-office with doctors. A new report in Health Affairs demonstrates how SDM can further drive value-based care in the emergency department.