CMS http://cms.hhs.gov has selected nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model supporting higher quality and more coordinated cancer care. The Medicare arm of the “Oncology Care Model” (OCM) https://innovation.cms.gov/initiatives/oncology-care includes more than 3,200 oncologists and will cover about 155,000 Medicare beneficiaries.
Participating practices covering urban, suburban, and rural areas, range in size from solo oncologists to large practices with hundreds of providers. Other payers are commercial insurers that will align their oncology payment models with Medicare’s model and support OCM practices in their transformation.
The OCM encourages practices to improve care and lower costs through episode and performance-based payments rewarding high quality patient care. 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 participating practices in OCM must provide enhanced services such as care coordination and navigation and use the national treatment guidelines for care. OCM is a five year model beginning July 2016 and will go through to June 30, 2021.