The CMS should focus more on patient education and engagement when it develops alternative payment models such as the Kidney Care Choices Model, members of the CMS Advisory Panel on Outreach & Education said Wednesday.
While many healthcare experts think alternative payment models give providers incentives to deliver cost-effective and high-quality care, patients could see it differently. They might think that their doctor is recommending a course of treatment because that's how their physician gets reimbursed, not because it's the best choice, said Dr. Margot Savoy, vice chair of the advisory panel and chair of Temple University Physician's department of family and community medicine. It could "feel shady to them."
"I can already hear my patients telling me that their kidney doctor is making them do their dialysis at home and making them have a transplant because that's how they get paid," Savoy said.
Patients need to be informed that they're participating in a payment model demonstration, but written notice isn't enough. They need to be educated about why the course of treatment—such as home-based dialysis or transplantation—that their doctor recommends is best practice. Written communications should be in "plain English" and account for differences in health literacy.
When people are receiving a new type of care, they need to be able to figure out whether it's better or worse than the care they had been receiving, said Allyson Schwartz, a former congresswoman from Pennsylvania and president and CEO of the Better Medicare Alliance.
"It doesn't sound better if it feels like they're being experimented on," she said.
The CMS should use focus groups to test notifications and other consumer-facing materials to make sure that they're useful, the panel said.
Patients should also have a "sit down" conversation with a care team member like a nurse or social worker to explain their options—including their ability to opt-out—and their associated costs and benefits to make sure that patients are engaged in the decision-making process, advisory panel members said. They also recommended that providers give patients a resource that they can follow up with if they have questions, as well as a follow-up call with the patient.
Patient navigators could also go a long way to addressing some of the questions and concerns of patients while improving adherence to treatment and the coordination of care.