The CMS Innovation center (CMMI) recently announced the development of a new payment and delivery model to improve the effectiveness and efficiency of specialty healthcare. The new Oncology Care Model (OCM), one of several models being developed by CMMI, requires participating physician practices that administer chemotherapy to enter into payment agreements with CMS to measure financial and performance accountability for episodes of care. Incentives in OCM include a monthly per beneficiary-per month (PBPM) payment of $160 for the entire duration of the episode, along with the possibility of a performance-based payment to foster quality care at a lower cost during the episode. CMS hopes to encourage participation by private payers, which would allow for a multipayer model to incentivize care transformation at the physician practices.
The deadline for submitting the CMS application for participation in the OCM has passed. If your center has applied, we are interested in learning how your institution or cancer center plans to meet the OCM requirements. The intent is to create a forum for ideas to flow among the oncology community on how to make the OCM feasible in clinical practice.
Matthew Kemmann of the UH Seidman Cancer Center shared their approach to the OCM below.
“In terms of implementation of the OCM at the UH Seidman Cancer Center, care coordination will be managed via a primary nursing model in the ambulatory clinic where the nurse is the center of the care team. To make it scalable and to have something we can take to the payers and make it sustainable, we have to add resources very sparingly. To free up time for our ambulatory nurse partners and enable them to increase the amount of direct patient care, we are proposing a three-part approach. An oncology nurse call center is designed to handle many of the incoming calls that would otherwise go to the clinic. A new role called “Pre-Authorization Liaison” will perform pre-certification tasks, as well as patient financial counseling and some basic documentation. Finally, clinical coordinators – a clerical role supporting the clinical team – will assume much of the remaining clerical tasks and indirect patient care functions from the nurses to improve clinic efficiency.
For the OCM’s care plan requirement, we will enhance our existing patient-centric care plan used by our care coordination program funded by a CMS CMMI Round 2 Award. This document is designed to increase patient engagement and patient education by stimulating conversations between coordinators and patients, also serving as a reference for each patient and his/her entire care team days later.“
We invite you to leave a comment below to share your thoughts on how your institution is preparing for the Oncology Care Model. Its an open forum and will help to shed light on how as an industry we are gearing up for this payment model.