What is the Shared Decision Making Payment Model?

In December 2016, the Center for Medicare and Medicaid Innovation (CMMI) announced a new payment model test as part of its Beneficiary Engagement Incentives program that aims to integrate shared decision making (SDM) into the routine clinical practices of ACOs.  After including SDM in provider quality measures, this payment model represents a new level of commitment to bringing the practice to scale. 

SDM enables patients to get more informed and engaged in their care – especially as it relates to important treatment decisions – and helps them collaborate with their providers to make choices that fit their clinical situation, goals and preferences best.  Better treatment decisions result in greater satisfaction with and adherence to care,  The SDM Model aims to help Medicare ACOs provide these benefits for more of their patients, while improving their population’s outcomes and their position for shared savings.  

How does the SDM model work?

Participants in the SDM model will receive $50 per SDM service encounter for all Medicare beneficiaries with any of six conditions:

Stable ischemic heart disease

Hip osteoarthritis

Knee osteoarthritis

Back pain (stenosis and/or herniated disc)

Localized prostate cancer

Benign prostate hyperplasia (BPH)

It’s important to remember that CMS will issue a payment of $50 for all SDM service encounters with Medicare beneficiaries – not just those in the ACO population. Only the cost of the encounters for the ACO population will be included in the ACO’s cost of care for the year.

What does the SDM model involve for ACOs and affiliated providers? 

The SDM Model requires participating ACOs to use a structured process that entails the following steps:

Identifying eligible beneficiaries that have one of the conditions listed above

Distributing evidence-based decision aids that match the relevant condition

Furnish the SDM service (includes discussion with provider, decision and documentation thereof)

Tracking and reporting

WiserCare supports each step in the SDM model process. We provide a platform solution for SDM that addresses all of the six preference-sensitive conditions required by the SDM Model, meets the evidence-based decision aid criteria set forth by CMMI, and can be easily delivered to patients via email or patient portal.  The output of WiserCare’s patient decision support experience is shared with the appropriate care team and used in the appointment to reach a decision. We also provide any patient or provider surveys and reporting that may be required.    

Who can participate?

The payment model test is open to all Medicare ACOs, both Next Generation ACOs and MSSPs.  The only excluded practices include those participating in CPC+, Oncology Care, and Million Heart Cardiovascular Disease Reduction Models

How can we participate?

Interested ACOs must file non-binding letters of intent and applications by March 5, 2017.  The application is relatively short. From the group of applicants, CMMI will select up to 50 to participate in the model.

What are the key dates to know?

*The initial award is for a two-year period, with up to three one-year renewals thereafter.