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CMS Looks to Increase Patient Engagement with New Models

December 8, 2016
by Rajiv Leventhal
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The Centers for Medicare & and Medicaid Services (CMS) has announced two new models from the CMS Innovation Center (CMMI) that will aim to increase patient engagement in care decisions by putting more information in the hands of Medicare beneficiaries.

These two beneficiary engagement and incentives (BEI) models are the Shared Decision Making Model (SDM Model) and the Direct Decision Support Model (DDS Model), CMS said in a Dec. 8 blog post. The BEI models will look to test different approaches to shared decision making, acknowledging that beneficiaries make decisions regarding treatment options in a variety of ways, and that facilitating a better understanding of their health and healthcare decisions is key towards improved beneficiary engagement, according to CMS.

Specifically, wrote Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS, the SDM Model will test the integration of a specific, structured four-step process to shared decision making into routine clinical practice workflows of practitioners participating in accountable care organizations (ACOs), which have the potential to result in informed and engaged beneficiaries who collaborate with their practitioners to make medical decisions that align with their values and preferences. This model seeks to determine if this design results in improved beneficiary outcomes and lower Medicare spending while maintaining or improving quality, and whether it results in increased beneficiary satisfaction with care decisions.

Beneficiaries who have one of the six preference-sensitive conditions will be offered an in-person collaborative process by their clinician that can help them understand and thoughtfully weigh their treatment options. These conditions include: stable ischemic heart disease, hip or knee osteoarthritis, herniated disk or spinal stenosis, clinically localized prostate cancer (cancer that is confined to the prostate gland), and benign prostate hyperplasia. For example, information provided will help the beneficiary decide whether surgery or other medical treatments are the right choice for them.

The DDS Model, meanwhile, looks to test an approach to shared decision making provided outside of the doctor’s office, by decision support organizations that provide health management and decision support services.  For example, Conway wrote, beneficiaries will be contacted by these organizations and provided access to a website or electronic application that provides them with unbiased and evidence-based information on their condition and/or treatment options. The beneficiary can then bring this information to their doctor’s office to enable them to consider their options with their clinician. As such, a major goal of the DDS Model is to encourage beneficiaries to have a greater role in their care by building and fostering the physician-patient relationship.

The SDM Model stipulates the use of decision aids and a structured four-step process to be applied at all participating ACO practices, and expects to engage over 150,000 Medicare beneficiaries annually. The DDS Model, meanwhile, uses organizations that are responsible for engaging an assigned population of Medicare fee-for-service beneficiaries in ongoing communications and medical decision support on behalf of CMS. These organizations may be commercial firms that already provide similar health information and decision support services to insured populations. Decision support organizations will not be healthcare providers or suppliers, will not engage in the practice of medicine, and will not interfere with the practitioner-patient relationship, CMS said. The model expects to reach 700,000 Medicare fee-for-service beneficiaries annually.

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