- These projects will be a part of the Beneficiary Engagement and Incentives (BEI) Model, said Patrick Conway, MD, Acting Principal Deputy Administrator of CMS and Andy B. Bindman, MD, Director of AHRQ, in a blog post.
“Beneficiary engagement broadly refers to the actions and choices of individuals with regard to their health and health care, and these decisions impact cost, quality and patient satisfaction outcomes,” they wrote.
“The BEI models will 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 health care decisions is key towards improved beneficiary engagement.”
The two initiatives are called the Shared Decision Making (SDM) Model and the Direct Decision Support (DDS) Model. Both will build off of past CMS ideas, and are geared toward educating and engaging the patient inside and outside of the doctor’s office, respectively.
Shared Decision Making Model
The SDM Model entails a specific four-step strategy to be deployed in accountable care organizations. According to a CMS fact sheetl, this strategy includes “identifying SDM eligible beneficiaries, distributing the PDA to eligible beneficiaries, furnishing the SDM Service, and SDM tracking and reporting. ”
CMS will offer participating ACOs financial support to carry out each of those steps. While the SDM Model will be considered an alternative payment model (APM), it will not count as an Advanced APM or MIPS APM under the Quality Payment Program, CMS says.
ACO providers can deploy the strategy with patients with a specific set of conditions, including 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.
Ultimately, CMS and AHRQ intend for this model to help improve treatment quality while keeping costs down. Additionally, the agencies hope to see improved patient satisfaction and higher rates of shared decision-making.
According to Conway and Bindman, the agencies expect to engage 150,000 Medicare beneficiaries with this program annually.
Direct Decision Support Model
The DDS Model is an outpatient model that centers on improved patient engagement through enhanced educational materials. CMS and AHRQ will enlist Decision Support Organizations to disseminate these materials and other patient supports.
While Decision Support Organizations will not deliver treatment or other healthcare services, they will contact eligible patients and offer them access to decision support materials, such as patient portals, educational websites, and specific learning tools.
From there, patients can inform themselves of their conditions and their treatment options, and engage in a conversation about them with their providers.
The patient-provider relationship is the bedrock of this model, Conway and Bindman say, and will rely on a provider’s ability to discuss a patient’s knowledge of their care.
“It will use patient-friendly material to educate patients about their condition and encourage them to have a conversation with their practitioners about care options to determine what care is best for them,” the pair wrote.
“Providing information directly to patients about their health decisions acknowledges that patients make decisions about their medical conditions outside of, as well as inside, their doctor’s office.”
Additionally, this model will test whether it is possible to engage patients outside of the doctor’s office and if that is effective in driving positive care outcomes.
Ultimately, the agencies expect Decision Support Organizations to engage 700,000 Medicare fee-for-service beneficiaries annually.
CMS and AHRQ will evaluate these two programs separately each year, with the goal of improving care quality while decreasing spending.
According to Conway and Bindman, these models are a part of both agencies’ overarching efforts to improve healthcare delivery through patient engagement.
“Engaging and empowering individuals to take ownership of their health involves giving people the tools they need to navigate the health care system – making health care information more accessible and helping to ensure that the patient’s voice is heard,” they said.
“These models will look to move beyond current practices and examine new ways to engage with patients with regard to their health and health care, and hopefully increase quality of care delivered, increase patient satisfaction, and provide value in the cost of care delivered.”
CMS and AHRQ are seeking participants for both models. For the SDM model, they are seeking Medicare Shared Savings Program and Next Generation ACOs. For the DDS Model, they are seeking Decision Support Organization applicants.
Those interested in either program may submit a letter of intent by March 5, 2017.