Advancements in Oncology Care Model Collaborative

7/20/2016

On June 29, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the 196 physician group practices and 17 health insurance companies selected to participate in the Oncology Care Model (OCM).  Initially announced last year, OCM is the first multi-payer, physician-led care model aimed at improving treatment for Medicare beneficiaries.  Scheduled to be implemented from July 1, 2016 to June 30, 2021, it is intended to show advances in the effectiveness and efficiency of specialty care.

Scope

According to the agency, the Medicare arm of the Oncology Care Model will include more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide. Participating practices include urban, suburban and rural areas and range in size from solo oncologists to large clinics with hundreds of physicians. CMS will provide a method for participants to share and diffuse resources, tools, ideas and data-driven approaches to care.  Dual participation in OCM and other programs is allowed in some cases.

Georgia Based Contributors

In Georgia, the participants are:

·         Augusta Oncology Associates, P.C.; Augusta;

·         Cancer Center of Middle Georgia, LLC, Dublin;

·         Central Georgia Cancer Care, P.C., Macon;

·         Harbin Clinic, LLC, Rome;

·         The Longstreet Clinic, P.C., Gainesville;

·         Northeast Georgia Diagnostic Clinic, LLC, Gainesville; and

·         Northwest Georgia Oncology Centers, P.C., Marietta.

Details of Participation and Structure

OCM participants will agree to financial and performance accountability for six-month episodes of care that will cover almost all types of cancer.  OCM incorporates a two-part payment system for participating practices.  This layout is intended to create incentives to improve the quality of care and provide enhanced services for patients who undergo chemotherapy treatment for a cancer diagnosis. The two forms of payment include a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the length of the treatment and the possibility of a performance-based payment for periods of chemotherapy care. The $160 MEOS payment aids participating practices in effectively managing and coordinating care for oncology patients.  The possible for performance-based payment incentivizes practices to lower the total cost of care and improve care for beneficiaries during treatment.

It is designed with two risk options: one-sided and two-sided tracks.  In the one-sided track, the physicians will not be responsible for any expenditures that exceed the target price set by CMS.  In the two-sided track, participants will have the option to take on downside risk in the third year.  In addition, the two-sided risk track is considered an Advanced Alternative Payment Model under the newly proposed Medicare Access and CHIP Reauthorization Act.

CMS is also partnering with seventeen commercial payers who have agreed to provide enhanced services to Medicare patients.  These provisions include care coordination, navigation, ability for patients to communicate 24/7 with an appropriate clinician with access to patient medical records and national treatment guidelines for care.

An episode of care includes all Medicare Part A and Part B services, as well as some Part D costs.  Treatments and services prior to the triggering chemotherapy session are not included in the episode.  Participating practices must use HER systems and commit to data-driven continuous quality improvement. 

Quality Measures

OCM selected quality measures across four National Quality Strategy Domains: Communication and Care Coordination, Person and Caregiver-Centered Experience and outcomes, Clinical Quality of Care, and Patient Safety. In addition, CMS will facilitate the need for feedback and assist in the sharing of data, results and best practices during the course of the five years.

 

Resources

Centers for Medicare & Medicaid Services. “Oncology Care Model.”  innovation.cms.gov/initiatives/oncology-care/

Institute of Medicine. “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis.”

Mitchel, Lynsey, Lam, Vanessa.  “CMS Oncology Care Model Reforming Payment for Beneficiaries with Cancer.”  The National Law Review.  www.natlawreview.com