In order to align with care that patients value, it is imperative that alternative payment models incorporate high-quality decision aids to mitigate the potential for driving “one-size-fits-all” care. Patient groups are prioritizing the development of shared decision-making tools, informed by their work to identify and reach patients from whom we can learn about the real-world impact of treatments. And patients need the ability to make informed choices about their care so that we are not wasting health care resources on treatments that don’t achieve what the patient wants. While the program for shared decision-making in accountable care organizations currently underway at CMMI is a good start, the agency should develop standards for shared decision-making that assure their implementation in a manner that is transparent, understandable to patients, and broadly disseminated for use. High quality shared decision-making should be a core component of all new models going forward.
By contrast, policies that seek to standardize care in a manner that has the potential to limit patient access to care that is suited to their needs, preferences and outcomes only serve to hinder the promise of personalized medicine. Medicare beneficiaries are not a homogenous population. Patients have varying levels of functionality; some continue to be runners or play sports, while others may be less active. Therefore, it is vital that the device or treatment chosen for each beneficiary be appropriately suited to their personal needs, preferences and outcomes. It is also imperative that patients in alternative payment models or other demonstrations are provided access to protections, such as a rapid appeals process or access to an ombudsman, that would allow for a more individualized approach to their care.
Engaging the patient community is a complex task that requires more than the notice and comment processes traditionally used by regulatory agencies. However, a more structured process for patient engagement that leverages CMMI’s own best practices, along with creative methods employed by organizations such as the Patient-Centered Outcomes Research Institute (PCORI) and the Food and Drug Administration’s Patient Focused Drug Development Initiative, will ensure that the patient perspective is well represented in CMMI’s model tests and improve their likelihood of success.
With patient engagement, we look forward to the introduction of new models with support and buy-in from the impacted patient communities that will be integral to their success.