The Center for Medicare and Medicaid Services (CMS) Innovation Center has developed the Beneficiary Engagement and Incentives (BEI) Models to test various approaches to shared decision-making, both in and out of the clinical setting. These models are premised on the fact that beneficiaries of health care make decisions about treatment options in many different ways and that there are lessons to be learned as to how individuals make these choices and their impact on cost, quality, and patient satisfaction.
The Shared Decision Making (SDM) Model will focus on six conditions that offer an array of treatment options: stable ischemic heart disease; hip osteoarthritis; knee osteoarthritis; herniated disk and spinal stenosis; clinically localized prostate cancer; and benign prostate hyperplasia. The Model will require an intervention group of practices participating in 50 Accountable Care Organizations (ACOs) nationwide to utilize a four-step process in their routine clinical practice for making decisions around these particular conditions. There will be an equal number of comparison group ACOs. To be eligible, ACOs must participate in the Medicare Shared Savings Program or Next Generation ACO Model. The Model will pay ACO awardees $50 per SDM service.
Alternatively, the Direct Decision Support (DDS) Model will examine decision making outside of the doctor’s office. This model will target the same six “preference-sensitive” conditions as well as a wider range of acute and chronic conditions. Specifically, the model will employ Decision Support Organizations (DSOs) to provide decision support to the majority of Medicare Fee for Service beneficiaries. While the SDM Model is anticipated to engage 150,000 beneficiaries annually, the DDS model is expected to engage approximately 700,000 beneficiaries each year.
To be eligible, DSOs must apply to serve a state and/or region (and are given the flexibility to determine their proposed region), with only one awardee per given geographic area. Each DSO will be responsible for a minimum of 100,000 Medicare beneficiaries. Payment will be in the form of a fixed amount per beneficiary per month, with 25% withheld as a performance incentive for DSOs to earn on an annual basis.
The initial test period for both BEI Models will be two years with the potential for three year-by-year renewals. SDM Letters of Intent and DDS Letters of Intent are mandatory and due along with full applications by March 5, 2017.