CMS announces two new models for testing shared decision-making

CMS is asking for applications to test two different approaches to shared decision-making: one for accountable care organizations (ACOs) and another for care outside of office visits. 

The goal is increase quality of care by helping patients better understand their treatment options and their health information, building off success seen in specialties like radiation oncology.

“They may not know what questions to ask clinicians, or feel that their values and preferences were considered and respected when a final decision for their treatment is reached,” wrote CMS CMO Patrick Conway, MD, and Agency for Healthcare Research and Quality Director Andy Bindman, MD. “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.”

The first model, called the Shared Decision Making (SDM) Model, will test how to adapt clinical practice at ACOs into a four-step decision-making process: identifying eligible beneficiaries, distributing patient decision aids, offering an in-person collaborative process to understand treatment options and then tracking and reporting outcomes.

To focus on beneficiaries who need help understanding options, the model will be limited to those with conditions where clinical evidence doesn’t support one option over another. The six “preference-sensitive” conditions will be: stable ischemic heart disease, hip osteoarthritis, knee osteoarthritis, herniated disk and spinal stenosis, clinically localized prostate cancer (cancer that is confined to the prostate gland) and benign prostate hyperplasia (BPH).

It will be available only to ACOs already participating in the Medicare Shared Savings Program or Next Generation ACO. Those chosen will receive financial assistance from CMS to “invest in a structured process that it believes will reduce or keep neutral Medicare spending while maintaining or improving quality, and will also result in improvements in patient engagement and experience with care.” For each SDM service performed, an ACO will receive $50.

The second model, called Direct Decision Support, has a broader scope. Using seven “Decision Support Organizations (DSOs),” CMS will try to engage 700,000 beneficiaries with those same preference-sensitive conditions outside of their office visits. DSOs won’t be offering healthcare services themselves, but instead will “provide information that encourages beneficiaries to take an active role in their own care and also improve the dialogue with their practitioner.”

“Decision Support Organizations will not be health care providers or suppliers, will not engage in the practice of medicine, and will not interfere with the practitioner-patient relationship,” Conway and Bindman wrote.

The two models will be judged separately, as the goal is to see what aspects of these approaches can reduce spending without reducing quality.

Applications for both models will be accepted through March 5, 2017.