On February 12, 2015, the U.S. Department of Health and Human Services (HHS) announced its new Oncology Care Model, a multipayer payment and care delivery model intended to support better coordination for cancer care. The initiative will include 24-hour access to practitioners for beneficiaries undergoing cancer treatment and is based on coordinated, person-centered care, aimed at rewarding value of care, rather than volume.
“Based on feedback from the medical, consumer, and business communities, we are launching this new model of care to support clinicians’ work with their patients,” said Patrick Conway, MD, Centers for Medicare & Medicaid Services (CMS) Chief Medical Officer and Deputy Administrator for Innovation and Quality. “We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide.”
As part of the Department’s approach to improving health delivery, the Oncology Care Model is one of many innovative payment and care delivery models developed by the CMS Innovation Center and advanced by the Affordable Care Act. The model was created in response to feedback from the oncology community, patient advocates, and the private sector that a new way of paying for and delivering oncology care is needed. This model will invest in physician-led practices, allowing the practices to innovate and deliver higher-quality care to their patients.
A Closer Look at the Model
The model focuses on three key areas: (1) linking payment to quality of care, (2) improving and innovating in care delivery, and (3) sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy.
The Oncology Care Model encourages participating practices to improve care and lower costs through episode-based, performance-based payments that financially incentivize high-quality, coordinated care. Participating practices will also receive monthly care management payments for each Medicare fee-for-service beneficiary during an episode to support oncology practice transformation, including the provision of comprehensive, coordinated patient care.
“With the Oncology Care Model, CMS has the opportunity to achieve three goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people,” added Dr. Conway. “As a practicing physician and son of a Medicare beneficiary who died of cancer, I know the importance of well-coordinated care focused on the patient’s needs.”
Physician group practices and solo practitioners who provide chemotherapy for cancer and are currently enrolled in Medicare may apply to participate. Other payers, including commercial insurers, state programs, and Medicaid managed-care plans, are also encouraged to apply.
To be considered, interested payers must submit a letter of intent through the Oncology Care Model inbox at OncologyCareModel@cms.hhs.gov by March 19, 2015. Interested practices must submit letters of intent by April 23, 2015. Practices and payers who submit a timely letter of intent will be sent an authenticated web link and password with which to submit an electronic application. Applications must be submitted by June 18, 2015. ■
Disclosure: Dr. Conway reported no potential conflicts of interest.
While commending the Centers for Medicare & Medicaid Services (CMS) for seeking new approaches to physician payment, ASCO expressed concerns over the model’s limited scope. “We are disappointed [CMS has] chosen to pursue only one model—and one that continues to rely on a broken fee-for-service...