CMS' new models to improve patient engagement: 8 things to know

The CMS Innovation Center plans to test two new models designed to improve patient engagement in their care decisions, the agency announced Thursday in a blog post.

"HHS identifies the engagement of Medicare beneficiaries as a cornerstone to achieving better care, smarter spending and healthier people," Patrick Conway, MD, principal deputy administrator and CMO of CMS, and Andy Bindman, MD, director of the Agency for Healthcare Research and Quality, wrote in the post.

The Beneficiary Engagement and Incentives Models will allow CMS to test different approaches to engaging Medicare patients in their care and achieve better outcomes. Below are eight things to know about the models.

The Shared Decision Making Model

1. Participating providers would integrate a specific four-step process to shared decision making into their clinical practice workflows for certain diagnoses that do not have one clear, evidence-supported treatment option. The six preference-sensitive conditions are:

  • Stable ischemic heart disease
  • Hip osteoarthritis
  • Knee osteoarthritis
  • Herniated disk or spinal stenosis
  • Clinically localized prostate cancer
  • Benign prostate hyperplasia

2. Beneficiaries would receive in-person decision support directly from their clinicians in this model.

3. CMS will select 50 ACOs nationwide as an intervention group and 50 for a comparison group to test this model. Only ACOs in the Medicare Shared Savings Program or Next Generation ACO Model are eligible for selection. Initially, the test will last two years, and then CMS will offer year-by-year renewals.

4. ACOs participating in the SDM Model will receive $50 for each SDM service performed by a practitioner.

Find more information on the SDM Model here.

The Direct Decision Support Model

5. In this model, decision support organizations — organizations that provide health management and decision support services — will contact beneficiaries separately from their clinicians to give them patient-friendly educational materials and encourage them to speak with their care providers. "This model is designed to determine whether engaging beneficiaries outside the clinical care setting will enable them to become more informed, empowered and engaged healthcare consumers," according to the blog post.

6. CMS plans to partner with up to seven decision support organizations to empower 700,000 Medicare fee-for-service beneficiaries who have one of the six preference-sensitive conditions:

  • Stable ischemic heart disease
  • Hip osteoarthritis
  • Knee osteoarthritis
  • Herniated disk or spinal stenosis
  • Clinically localized prostate cancer
  • Benign prostate hyperplasia

7. CMS will select decision support organizations, which will have to commit to two years of participation. Then, the agency will select three organizations for year-by-year renewals.

8. DSOs participating in the DDS Model will receive a fixed per beneficiary per month payment. A quarter of the payment will be withheld as a performance incentive.

Find more information on the DDS Model here.

Separate independent evaluations of each model will be performed to see if the model improves care without increasing spending, reduces spending without negatively affecting quality or improves quality and also reduces spending.

"These models will look to move beyond current practices and examine new ways to engage with patients with regard to their health and healthcare, and hopefully increase quality of care delivered, increase patient satisfaction and provide value in the cost of care delivered," according to the blog post.

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