The Department of Health and Human Services has announced that nearly 200 physician group practices – more than double the number expected – and 17 health insurance companies will be participating in the Oncology Care Model, a voluntary payment and care delivery model developed by the CMS Innovation Center and advanced by the Affordable Care Act. The 5-year program, designed to improve cancer care by providing financial incentives to physician practices that provide effective treatment, is set to begin July 1, 2016.
The Medicare arm of the Oncology Care Model (OCM) will include more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide, according to a written statement from the HHS.
Avalere Health
Geographical Distribution of Physician Practices Selected to Participate in the OCM
“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” Patrick Conway, MD, CMS principal deputy administrator and chief medical officer, said in the statement.
Physician practices from 31 states will be participating, with the highest levels of provider participation in Alabama, California, Illinois, New Jersey, New York, Ohio, Pennsylvania, and Virginia, according to an analysis conducted by Avalere Health, a Washington, DC–based health care consulting firm.
The CMS first announced the OCM project in February 2015 and originally aimed to have 100 physician practices participating in the first-ever oncology-specific payment reform model.
“Based on feedback from the medical, consumer, and business communities, we are launching this new model of care to support clinicians’ work with their patients,” HHS Secretary Sylvia M. Burwell said in a written statement in February 2015.
Courtesy HHS
Sylvia Burwell
“We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide. Improving the way we pay providers and deliver care to patients will result in healthier people,” she said.
The OCM encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care. It is a multipayer model that includes Medicare’s fee-for-service (OCM-FFS) and commercial payers.
OCM participants will receive regular OCM-FFS payments during the model. To create incentives to improve the quality of care, reimbursement will include a monthly payment of $160 per beneficiary for delivery of OCM enhanced services, and a performance-based payment for OCM episodes, according to a CMS fact sheet.
An OCM-FFS episode begins on the date of initial Part B or D chemotherapy claim and includes all Medicare Part A and B (and some Part D) services received during the episode period which lasts 6 months. Beneficiaries who receive chemotherapy after the end of an episode will begin a new episode.
Enhanced services include patient navigation, a care plan based on the Institute of Medicine care management report, patient access 24 hours a day, 7 days a week, and treatment with therapies that are consistent with nationally recognized clinical guidelines.
View the complete list of participating practices at https://innovation.cms.gov/initiatives/Oncology-Care.
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