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CMS Announces Multi-Payer, Coordinated Care Oncology Model
The Centers for Medicare & Medicaid Services (CMS) has announced that 17 commercial health insurers alongside nearly 200 physician groups will all take part in their 5-year Oncology Care Model (OCM), a new, innovate approach to delivering care to patients with cancer.
In the United States, cancer affects more than 1.6 million people each year, a significant proportion of whom are over 65 years old and are also Medicare beneficiaries.
The CMS OCM, an innovative, multi-payer model focused on providing higher quality, more coordinated oncology care, will begin on July 1, 2016, and will run through June 30, 2021. Approximately 155,000 Medicare beneficiaries nationwide will be covered by the Medicare arm of the OCM.
The OCM has exceeded its goal for participant enrollment, with more than double the anticipated number of oncology physician groups signing up for the program, CMS announced. Patrick Conway, MD, chief medical officer and principal deputy administrator of CMS, said in a statement, “It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care.”
Under OCM, CMS has the opportunity to support better quality care and health as well as lowering costs for patients with cancer. CMS will track patient performance across multiple domains across four of the National Quality Strategy Domains, including Communication and Care Coordination; Person and Caregiver-Centered Experience and Outcomes; Clinical Quality of Care; and Patient Safety. Furthermore, the new model will use 12 quality measures to calculate patient performance-based payments. Ongoing feedback will be provided to practices throughout the term of the model.
According to CMS the OCM, “aims to promote whole practice transformation through the use of aligned financial incentives, including performance-based payments, to improve care coordination, appropriateness of care, and access for fee-for service (FFS) Medicare beneficiaries undergoing chemotherapy.”
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