Harm Prevention

Understanding the Oncology Care Model

Cancer is one of the most prevalent and devastating diseases in the United States. While the disease impacts individuals of all ages, the largest proportion of cancer patients are over 65 and Medicare beneficiaries.1 As part of the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the Oncology Care Model (OCM) was created to test new payment models and services delivered to cancer patients. The five-year model is designed to test strategies that drive quality outcomes while reducing costs for care provided for six months following a patient’s first chemotherapy treatment.1
oncology patient
The model includes a two-part payment approach:
  • Monthly Enhanced Oncology Services (MEOS) Payments: which pay for enhanced services delivered to beneficiaries
  • Performance-Based Payment (PBP): which encourages member practices to improve quality and reduce costs across the six-month episode of care
In addition to incentive payments, the model also requires that participating practices implement a practice redesign initiative aimed at improving cancer patient outcomes and quality of life. These requirements include:
  • Enhanced patient services including patient navigation, a comprehensive care plan, 24x7 patient access, and treatments and therapies that adhere to national clinical guidelines
  • The use of data to drive continuous quality improvement
  • The use of certified electronic health record technology3
Performance is tracked through a set of quality measures that span claims-based and practice-reported measures that cover:
  • Communication and care coordination
  • Person and caregiver experience and outcome
  • Clinical quality of care2
Taken together, the OCM program aims to help transform cancer care in a way that empowers clinicians with the information and tools they need to drive quality outcomes. Through the OCM, participating practices are working to improve care coordination, symptom management, palliative care, and end-of-life care. And with the growing demand for high-quality cancer treatment, this program along with other innovation projects will push healthcare forward toward our shared goal of improved patient outcomes and the experience of care.

[1] Centers for Medicare & Medicaid Services, "Oncology Care Model," cms.gov, 09 06 2016. [Online]. Available: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-29.html. [Accessed 21 05 2018].

[2] Centers for Medicare & Medicaid Services Innovation Center (CMMI), Oncology Care Model Overview, Washington, DC: CMMI, 2018.

[3] Center for Medicare & Medicaid Services, "ONCOLOGY CARE MODEL OTHER PAYER (OCM-OP) CORE MEASURE SET," 07 05 2018. [Online]. Available: https://innovation.cms.gov/Files/x/ocm-otherpayercoremeasure.pdf. [Accessed 17 05 2018].

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