Medicare is Requesting Information on Engagement, Incentives and Behavioral Insights

From CMS:

The Centers for Medicare and Medicaid Services (CMS) is seeking input from stakeholders on the possibility of the Center for Medicare and Medicaid Innovation testing innovative models to increase the engagement of Medicare beneficiaries, Medicaid beneficiaries, Medicare-Medicaid enrollees, and/or Children’s Health Insurance Program (CHIP) beneficiaries in their health and health care. (more)

CMS specifically sites improving engagement in the self-management of diabetics as an example.

This may be an opportunity for us as the patient community to share the value we place on peer to peer support. Particularly with in the context of psycho-social aspects of diabetes care.

There are a number of specific question, most with sub questions, in the request for information. These are listed as comment to this thread below to facilitate ideas, conversations and articles supporting the ideas. Please share any ideas as replies to the questions.

Please! Jump in! With teamwork maybe we can create patient driven responses.

They are seeking information through a specific Request For Information (RFI) on the development of models focused on increasing beneficiary engagement. The submission period RFI submissions concludes 11:59 PM EDT on September 15, 2014.

Q1 Behaviors in beneficiary engagement models
The Innovation Center is considering several models to test different methods of engagement of CMS beneficiaries in modifiable aspects of their health care. Examples might include improving engagement and self-management of diabetics in the care of their disease, improving adherence of acute myocardial infarction survivors with the cardiac rehabilitation that is prescribed, improving influenza vaccination rates, and encouraging medication adherence by patients with chronic disease. The models would incentivize desirable behavior, rather than risk status or profiles. There is a wide range of additional and useful topics that could be undertaken. Please respond with answers to the following questions:
A - What model topic(s) should CMS support in this project? We are seeking both clinical models and other topics such as preventive services and community-based services. What are the reasons that the proposed topic should be chosen?
B - Is there a history of successfully operating projects or models on this topic? Please describe how similar models have operated in the past, and how this experience supports and informs how such a model could be used to support CMS beneficiaries.
C - Would the proposed model have a positive return on investment (ROI) for CMS (i.e., the savings would be greater than any additional costs), and is there evidence to support that ROI estimate?

Q2 - Beneficiaries included in the model.

CMS programs serve a wide variety of beneficiaries in its programs. Please identify the types of beneficiaries that are most appropriate to include in the proposed model.

  1. Describe the beneficiary groups who should be targeted by the proposed model(s). How many of them are there, which CMS programs are they enrolled in (i.e., Medicare, Medicaid, Medicare-Medicaid, or CHIP), and what are their other characteristics? Are there beneficiary types that we should avoid including in these models? What would be the impact of these models on low income groups?
  2. Why are the proposed beneficiaries particularly appropriate to include in the proposed model?
  3. Are there any specific protections that are needed for the beneficiaries who are recommended for the model(s)?

Q3 Tools proposed for use in the model.

There are a wide variety of tools taken from behavioral economics, social psychology, and other domains that may be useful to support the proposed model. Examples include using social norms, commitment mechanisms such as social contracts, default choice mechanisms, peer support groups, and incentive-based tools. CMS is not contemplating the use of negative incentives in these models.

  1. What innovative tools from behavioral economics, social psychology, and other domains would support the beneficiary engagement model? Why are these tools recommended, and what is the history of their successful operation for the proposed model topic?
  2. Are there technological tools that should be used as part of this model operation such as instant messages, internet links, webcams, video-conferencing, or other options that should be considered to improve the operation of the proposed model?

Q-4 Match of beneficiary behaviors and tools/methods.

CMS seeks to improve beneficiary engagement for matches of important beneficiary behaviors and appropriate tools and methods. What combination of beneficiary behavior and behavioral economics/social psychology methods would you recommend to improve beneficiary engagement in important areas of medical treatments and health services? The following matrix is for illustration only and is not intended to limit or influence your answer, but illustrates the point that beneficiary engagement in many combinations of tools/methods and beneficiary behaviors are possible.

Q 5 Operations of the proposed model.

CMS is especially interested in considering models that have practical prospects for successful implementation and operation and that have designs that lead to successful outcomes.

  1. What sorts of organizations should be solicited to operate the proposed models?
  2. How should the operators of the proposed model be paid? What would be the unit of payment (per-member per-month, per service, bundled payment, or other payment method)?
  3. What is the estimated amount that should be paid per beneficiary for operations?
  4. Is this model ready for current operation, or would the proposed model require significant research and development to implement?
  5. Is this model ready for current operation, or would the proposed model require significant research and development to implement?

Umm...This is the worst bureaucratize ever. I've got my husband, who was an Emergency Manager for PDX and had to deal with state and federal bureaucracies, working up a translation. It is a ridiculous questionnaire for anyone who isn't a bureaucrat. That is the first thing we need to tell them----get someone to write it in a language that a regular person with diabetes can understand. Yumpin' Yimminy!

I guess it is kind of obvious that they aren't actually asking patients. They talk about patients like they aren't even in the room. They are "beneficiaries."

Seem kind of strange to ask some back room insurance processor to provide behavioral insight into how to engage and incentivize patients.

I think they deserve an answer from patients. They might be surprised by the answers.

Brian I agree I have read this about 10 times and I think it has to be framed in context. This item is a Request For Proposals (RFP). Meaning they are not soliciting comment about the issue rather proposals for how to obtain alternative patient engagement with testing etc. So the intent here is to award a contract to someone who will run a demonstration about how to better the system.

So no, I do not see a patient piece here but I do not think that is a bad thing. So the question, does a patient oriented group want to file a response with a method for dong the job they are seeking done.

Or, more likely do we want to follow who gets the contract or who is working on the response to this RFP so we can work with them. Actually if we can find whoever is responding, we (patients), can strengthen their proposal and do ourselves some good at the same time.

Now the question, who are the likely responders and how do we get in contact with them? Assuming we (clients) want too..........................Rick

Judith I was trained in bureaucratize, and I agree. This thing was written for somebody (or a very few somebodies) not the general public. I suspect there is a likely contractor(s) who is pre-selected and who will get this contract. When you read stuff that is so opaque I have found it is a narrow band of contractors they are looking at.

I read this stuff for ten years for a job, every day. 5 days a week I read the Commerce Business Daily and the Federal Registrar looking for funding opportunities for the city I worked for. I was pretty good at it. I find this thing so opaque I had to read it 10 times to see the outline of what they want.

Oh one more thing, this mess is written with maximum wiggle room. Meaning they want to award a contract, but they cannot define the scope of work well. So they will be able to award it to who they want and justify the award based on all sorts of things from dozens of little parts of this RFP.

Oh and to defend my brother bureaucrats, Someone got the job of awarding a contract to someone and the only way they can legally do it, is to use the RFP process. Since the contract is going to a predefined vendor, you write something so crazy hard to understand that very few vendors will even attempt it and you can make the award based on legal criteria. If you view it like that, it is a wonderfully constructed piece of prose with a well defined purpose. Pure bureaucratic art. Like a Picasso, it can mean anything your boss decides they want. Of course also like a Picasso not all art is appreciated by the general viewer.

Proud trained bureaucrat for over 30 years LOL. Wonder why i am working on my writing? I used to read and write stuff like and I was pretty successful doing it.

I’m happy to read the responses to this. I read this post several times yesterday and wanted respond but my response would not have answered the posted questions. What I really wanted to answer is what a Medicare patient prefers or expects in the way of helping with diabetes management.

I say this because of my strong opinions regarding the test strip limits Medicare imposes as well as the non-coverage for CGMs. Both of these policies are penny-wise and pound foolish, but not an answer to the posted question.

Hi Rick!

I loved your explanation of what the RFP is about! I'm so glad that we have an expert like you here to interpret it! Thanks for clarifying it for the rest of us!

Best wishes!