CMS Cancels Another Innovation Center Model

The Direct Decision Support Model was designed to provide medical information to approximately 700,000 Medicare beneficiaries.

On Friday, CMS cancelled another of the initiatives developed by its Innovation Center (CMMI), citing “operational and technical issues.”

The Direct Decision Support (DDS) Model was intended to engage approximately 700,000 Medicare beneficiaries with preference-sensitive medical conditions, for which there is no evidential consensus for any single treatment option and patients are forced to make choices based on their values and preferences.

In the program, 7 groups would be selected to serve as Decision Support Organizations (DSOs), assigned geographically-determined populations. DSOs would have been asked to create electronic educational resources, like web-based tools, telephonic decision support, and mobile health apps for conditions like stable ischemic heart disease, hip or knee osteoarthritis, herniated disk, or spinal stenosis (among others)

The goal was to “[encourage] beneficiaries to take an active role in their own care and also improve the dialogue with their practitioner.” Medicare beneficiaries would have been free to opt out of receiving the information.

In a note added to the program’s webpage, CMS acknowledges the cancellation but does not specify the problems that led to it. “Changes necessary to continue with the DDS Model would be too significant and burdensome for participants, and would require a new solicitation,” the note says.

It was one of 2 so-called Beneficiary Engagement and Incentives (BEI) Models. The other, the Shared Decision-Making Model, was cancelled in November 2017 due to lack of interest. That program was meant to harness accountable care organizations to test a 4-step decision making process. That program was financially incentivized, and would have counted as an Alternative Payment Model.

The 2 BEI programs continue a trend of CMMI programs being reduced in scope or ended prematurely. At the start of December 2017, CMS reined in a mandatory bundled payment program and cancelled 2 others.

The CMMI was created by Section 3021 of the Affordable Care Act, which states that its purpose is to “test innovative payment and service delivery models to reduce program expenditures… while preserving or enhancing the quality of care furnished to individuals.”

Before Tom Price’s resignation from the top of the Department of Health and Human Services, speculation emerged that CMMI was in trouble. Price was a vocal critic of many of its programs. His replacement, Alex Azar, said in a confirmation hearing that he “[believes] CMMI is going to be one of the very important ways we have to drive this type of transformation, our healthcare system through Medicare.”

Writing in a Wall Street Journal commentary, CMS administrator Seema Verma “a powerful tool for improving quality and reducing costs,” but added that, “We are analyzing all Innovation Center models to determine what is working and should continue, and what isn’t and shouldn’t.”