HHS Announces Oncology Care Model

Added on Jul 22, 2016

HHS Announces Oncology Care Model Participants
From Industry Edge July 2016

After an open application and selection period, the U.S. Department of Health & Human Services (HHS) has selected 196 physician groups and 17 payers, in addition to the Centers for Medicare & Medicaid Services (CMS), to participate in the CMS Oncology Care Model (OCM), a multipayer model that aims to provide higher-quality, more highly coordinated oncology care at the same or lower cost to Medicare.

According to the HHS, the five-year model—which began July 1 and runs through June 30, 2021—is one of the new payment and delivery models that the Center for Medicare & Medicaid Innovation (CMS Innovation Center) developed to improve the effectiveness and efficiency of care. The practices participating in the OCM are Medicare-enrolled physician groups identified by a single taxpayer identification number and composed of one or more physicians who treat Medicare beneficiaries diagnosed with cancer. Other payers are commercial insurers that will align their oncology payment models with Medicare’s model and support OCM practices in their practice transformation efforts. In total, the model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide.

The OCM encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care. As part of the OCM, physician practices may receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary. The two-sided risk track of this model will be an Advanced Alternative Payment Model under the newly proposed Quality Payment Program, implementing provisions from the Medicare Access and CHIP Reauthorization Act of 2015.

CMS will track participant performance on multiple quality domains using patient- and practice-reported measures as well as claims-based measures. Quality measures were selected for OCM 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. CMS will provide ongoing feedback to practices throughout the model. In addition, the model uses 12 of these quality measures in the calculation of participants’ performance-based payments.

More information about the OCM, as well as the names of the participating practices and payers, is available at http://innovation.cms.gov/initiatives/Oncology-Care.