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The Enhancing Oncology Model

One June 30, 2016, The Centers for Medicare and Medicaid Services (CMS) announced the practices that will be participating in the Oncology Care Model (OCM).  Today Friday, July 1,  marks the start of the five-year Oncology Care Model, one of the first CMS physician-led specialty care models aimed at improving quality and reducing the cost of care.

This particular reimbursement program will involve multi-payer arrangements in which healthcare providers are responsible for performance and financial means during episodes of care much like within bundled payments. The Oncology Care Model (OCM) specifically targets chemotherapy administration to cancer patients.

Cancer is one of the most common and devastating diseases in the United States: more than 1.6 million new cases of cancer will be diagnosed and cancer will kill an estimated 600,000 Americans in 2016. According to the National Institutes of Health, based on growth and the aging of the U.S. population, medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion (in 2010 dollars) – an increase of 27 percent over 2010. A significant proportion of those diagnosed are over 65 years old and Medicare beneficiaries. By paying physicians based on financial and quality performance for an episode of care, CMS hopes to spur continuous quality and cost improvement while achieving better health outcomes for Medicare beneficiaries.

CMS released a fact sheet last year outlining the five-year Oncology Care Model, which is expected to improve care coordination and bring providers to reduce the costs associated with cancer treatment. With more than 1.6 million Americans diagnosed with cancer every year and a majority Medicare beneficiaries, CMS has begun partnering with oncologists and commercial health plans to ensure better quality of care at lower costs among cancer patients.

The U.S. Department of Health & Human Services (HHS) selected 17 payers and 196 physician practices to participate — almost twice the number it expected. To participate, physician practices must provide chemotherapy and meet several parameters regarding EHRs, patient access and care coordination, among other requirements. In addition to Medicare fee-for-service, the model includes state Medicaid agencies and commercial payers that are able to design their own payment incentives if they align with the Innovation Center’s goals.

The Oncology Care Model aligns with the goals of the federal agency to move the healthcare delivery system around the country to adhere with value-based care and quality instead of quantity of services seen with the traditional fee-for-service (FFS) payment models.

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The Oncology Care Model operates on an episode of care system and is reimbursed based on performance, similar to bundled payment programs. Financial incentives based around ensuring the right care for their patients involve the reduction of healthcare spending, CMS states in its fact sheet.

The fact sheet states, “OCM-FFS will use a two-part payment approach for participating oncology practices, creating incentives to improve the quality of care and furnish enhanced services for beneficiaries undergoing chemotherapy treatment for a cancer diagnosis. These two forms of payment include: 1) a monthly $160 per-beneficiary care management payment for Medicare FFS beneficiaries; 2) a performance-based payment for OCM episodes.”

“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” said Secretary Sylvia M. Burwell. “This patient-centered care model furthers the goal of the Vice President’s Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely.”

“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” said Patrick Conway, M.D., CMS principal deputy administrator and chief medical officer. “We have nearly doubled the number of participants that we anticipated. It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care. As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”

View the awarded OCM practices by clicking the below links:

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