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New Care Model Focuses on Chemotherapy Episodes of Care

March 25, 2015:

The Centers for Medicare and Medicaid Services’ Innovation Center just announced a new oncology payment and care delivery model aimed at reducing the costs while improving the quality of care provided to beneficiaries receiving chemotherapy treatment at physician-led practices. Providers who participate in the multipayer payment and care delivery model will be provided financial incentives over five years to cut costs while meeting certain quality standards.

Most of the more than 1.6 million Americans diagnosed with cancer each year are Medicare beneficiaries. Even a small reduction in costs per beneficiary would quickly add up to sizeable savings for Medicare.

The model has been developed with input from various oncology groups and associations. The Association of Community Cancer Centers (ACCC) comments that, while the model announced is promising, certain issues still need to be clarified, namely benchmark methodology, quality metrics, and practice transformation requirements.

Practices participating in the care model, scheduled for launch in the spring of 2016, will start out taking on one-sided risk, with the option of accepting two-sided risk the third year of the program. Initially, the Oncology Care Model will set a “target price” for six-month episodes of chemotherapy that is 4 percent below the fee-for-service payment. A portion of any savings beyond the target price will be returned to the practice.

Practices must achieve cost reductions while meeting quality criteria as outlined in the request for applications. These “performance-based” payments will be calculated after the completion of each six-month episode and paid to practices in semi-annual lump sums.

To sweeten the financial incentives, Medicare will offer a per beneficiary per month payment of $160 to help practices fund development of new ways to provide comprehensive, coordinated care.

The model will focus on:

  • Linking payment to quality of care
  • Improving care delivery through innovation
  • Support better decisions by sharing information among providers, consumers, and others while maintaining patient privacy

In particular, the OCM will zero in on chemotherapy treatment and the spectrum of care provided to a patient over a six-month episode after chemotherapy starts. Physician practices that want to participate in OCM must:

  • Provide the core functions of patient navigation
  • Document a care plan including the components described in “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis” (Institute of Medicine Care Management Plan, Institute of Medicine).
  • Provide around-the clock patient access to an appropriate clinician with access to the practice’s medical records
  • Provide therapies consistent with nationally recognized clinical guidelines
  • Continuously improve quality based on data
  • Use an electronic health record certified by the Office of the National Coordinator for Health Information Technology and attest to Stage 2 of EHR meaningful use by the end of the third model performance year

This is the second care model the Innovation Center has announced. The other one, announced early in 2013, focuses on end-stage renal disease care. The deadline to apply to participate was extended last spring, suggesting that providers were applying in lower numbers than CMS had hoped. Some commented that the financial incentives were not sufficient to balance the risk providers would have to take on.


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