The U.S. Department of Health and Human Services (HHS) has announced that it has selected nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality and more coordinated cancer care. The Medicare arm of the Oncology Care Model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide. The Oncology Care Model began on July 1, 2016, and will run through June 30, 2021.
Sylvia M. Burwell
“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” said Secretary
Sylvia M. Burwell. “This patient-centered care model furthers the goal of the Vice President’s Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely.”
The Oncology Care Model encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care. The Oncology Care Model is one of the first Centers for Medicare & Medicaid Services physician-led specialty care models and builds on lessons learned from other innovative programs and private-sector models.
Model Provisions
As part of this model, 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 Children’s Health Insurance Program Reauthorization Act of 2015.
Practices participating in the 5-year Oncology Care Model will provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on person-centered care. They will provide enhanced services to beneficiaries who are in the Oncology Care Model to help them receive timely, coordinated treatment.
For more information about the model including the names of those practices and payers participating, visit: http://innovation.cms.gov/initiatives/Oncology-Care/. ■
