CMS Innovation Center to test 2 new Medicare models tied to shared decision making

The Centers for Medicare and Medicaid Services Innovation Center, which is expected to be among the Affordable Care Act casualties of the Trump administration, has announced two new models designed to increase Medicare beneficiary engagement in their healthcare decisions.

The shared decision making model is open only to accountable care organizations and only participating ACOs that are in Next Generation or the Medicare Shared Savings Program will qualify for advanced alternative payment model payments under MACRA, the agency said.

The model will test whether a four-step process to integrate shared decision-making into routine clinical practice lowers cost while improving quality.

The model will pay participating ACOs $50 for each service. The four steps are: identifying eligible beneficiaries; distributing a patient decision aid; furnishing the service in discussion, decision and documentation; and tracking and reporting.

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Participating beneficiaries include those with stable ischemic heart disease, hip or knee osteoarthritis, herniated disk or spinal stenosis, clinically localized prostate cancer and benign prostate hyperplasia.

Beneficiaries with one of these six preference-sensitive conditions will be offered an in-person collaborative process by their clinician that helps them understand and weigh their treatment options, such as whether they want surgery or another type of medical treatment.

The second model called direct decision support tests an approach to shared decision making provided outside of the doctor's office.

Beneficiaries will be contacted by participating 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 and consider options with their clinician. The goal is to encourage beneficiaries to have a greater role in their care by building and fostering the physician-patient relationship.

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The organizations in this model may be commercial firms that already provide similar health information to insured populations. They may not be providers or suppliers.

CMS said it would partner with up to seven decision support organizations. The agency will provide population-based payments for engaging an assigned population of Medicare fee for service beneficiaries in ongoing communications and medical decision support on behalf of CMS.

The organizations will receive a fixed per beneficiary, per month payment for each beneficiary in the geographic region assigned to them.

Twenty-five percent of this amount will be withheld as a performance incentive, which the organizations will be eligible to receive on an annual basis if they meet performance metrics, CMS said.

Decision support organizations interested in participating in the model, and ACOs currently in the Medicare Shared Savings Program or Next Generation ACO Model that are interested in participating in the shared decision making model must submit an electronic, non-binding letter of intent for consideration. The submission period began on December 8 and closes on March 5, 2017.

CMS will conduct an independent evaluation of both models to determine whether they improve the quality of care without increasing spending or reducing spending.

Both of these models incorporate lessons learned in previous CMS projects that included patient engagement and shared decision making components.

Looking ahead, the Agency for Healthcare Research and Quality is working to advance the field with new grant funding for projects up to $1.5 million to develop, test and evaluate measures of shared decision-making for research conducted in clinical settings. 

Twitter: @SusanJMorse