Improving the Quality of Care for Medicare Beneficiaries by Increasing Patient Engagement

The Department of Health and Human Services (HHS) identifies the engagement of Medicare beneficiaries as a cornerstone to achieving better care, smarter spending, and healthier people. Our agencies – the Centers for Medicare & and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) – support the vision set forth in CMS’ Quality Strategy, of health and care that is person-centered, provides incentives for the right outcomes, is sustainable, emphasizes coordinated care and shared decision making, and relies on transparency of quality and cost information.

We know beneficiaries make health care decisions in a variety of ways. Often, these decisions involve multiple treatment options that can have different sets of advantages depending on the individual.  As such, beneficiaries may not always understand the health information that may be available online, in print or from their clinician and the options available to them.  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. 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.

With this in mind, CMS is announcing two new models from the CMS Innovation Center that will increase patient engagement in care decisions by putting more information in the hands of Medicare beneficiaries. These two Beneficiary Engagement and Incentives (BEI) Models are the Shared Decision Making Model (SDM Model) and the Direct Decision Support Model (DDS Model). 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. 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.