In the wake of the recent flurry of commentary on the answer to the question of “What will happen to the Affordable Care Act?” the Commonwealth Fund released a new survey addressing how high-needs patients experience health care in the United States. The survey underscores what many in the health care sector already know: that a small minority of patients (according to the survey, 10%), account for the majority (according to the survey, 65%), of healthcare spending in the United States. The survey brings to light the ever-elusive question, the answer to which still remains unclear: how do we as a nation lower healthcare costs and improve population health?

The advent of high deductible health plans has helped employers shift some of the cost burden onto their employees in an effort not only to save money, but more importantly, to have their employees understand healthcare costs and encourage them to be better consumers. Unfortunately, there is not only a lack of reliable data regarding the cost of healthcare services, but there are other “costs” that are difficult to quantify, i.e., socioeconomic determinants of health such as access to affordable housing and food insecurity. Further, patient engagement remains a work in progress as those in the industry continue to try to understand how best to promote shared decision making and ensuring that patients have the right tools and resources to manage their care.

The Centers for Medicare and Medicaid Services recently announced two new initiatives that will be offered through the Center for Medicare and Medicaid Innovation aimed at improving patient engagement. The two models are the Shared Decision Making Model (SDM Model) and the Direct Decision Support Model (DDS Model). According to a CMS blog post, “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 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.” The SDM Model will test a specific approach to integrate a structured four-part shared decision making process into the clinical practice of practitioners who are participating Accountable Care Organizations. The DDS Model will test an approach to shared decision making provided outside of the clinical delivery system by an organization that provides health management and decision support services. The goal of each of these initiatives is to increase patient engagement in care decisions by providing Medicare beneficiaries more information.

Another recent development is the passage of the 21st Century Cures Act, which contains, among other notable initiatives, sections aimed at improving behavioral healthcare for patients by strengthening laws mandating parity for physical and behavioral health care and provides grants to increase the number of psychologists and psychiatrists to ensure the availability of services for patients requiring such care. Addressing behavioral health needs as part of patient engagement is an important component of population health initiatives. In tandem, access to behavioral health care services, and other types of health care services via telemedicine, will have a boost in federal research if the House passes the ECHO Act. The Act will fund research into the use of telemedicine as a mechanism to expand and improve healthcare. With reimbursement for telehealth services varying across the United States and proponents touting telemedicine as a solution to access in underserved areas, the ECHO Act may further support efforts in patient engagement by linking patients, especially those in underserved areas, to the care they need.