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Evidence-Based Oncology February 2015

HHS Announces New Oncology Care Management Initiative

Laura Joszt
A new Affordable Care Act initiative from HHS will better coordinate cancer care with the intention of improving the quality of care provided and reducing the money spent on healthcare, according to an announcement from HHS.1

Cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010, with the majority of patients who are diagnosed older than 65 years and Medicare beneficiaries. The Oncology Care Model was developed by the CMS Innovation Center through feedback from the oncology community, patient advocates, and the private sector, with the aim of “better care, smarter spending, and healthier people,” according to HHS.

“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. Improving the way we pay providers and deliver care to patients will result in healthier people,” Patrick Conway, MD, CMS chief medical officer and deputy administrator for innovation and quality said in a statement.

CMS will invest in physician-led practices and allow them to innovate and delivery higher-quality care and is seeking participation of other payers. The model will provide episode-based, performance-based payments that incentivize high-quality, coordinated care. Practices that participate in the Oncology Care Model will receive monthly care management payments for each Medicare fee-for-service beneficiary during an episode.

The model will focus on 3 key areas: linking payment to quality of care; improving and innovating care delivery; and sharing information more broadly to providers, consumers, and others to support better decision while maintaining privacy.

“With the Oncology Care Model, CMS has the opportunity to achieve 3 goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people,” said Conway. “As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”

In response to the HHS announcement, the American Society of Clinical Oncology (ASCO) released a statement that expressed concern about the limited scope of the model. “We are disappointed they have chosen to pursue only one model—and one that continues to rely on a broken fee-for-service system,” said the chief medical officer of ASCO Richard Schilsky, MD, FACP, FASCO, in a statement. In response to a draft version of the model, ASCO says it had urged CMS to test models that would migrate away from the traditional fee-for-service system.2 EBO

1. New Affordable Care Act initiative to encourage better oncology care [press release]. Baltimore, MD: HHS; February 12, 2015. http://www.cms. gov/Newsroom/MediaReleaseDatabase/Pressreleases/ 2015-Press-releases-items/2015-02-12.html.

2. New CMS Oncology Care Model relies on broken fee-for-service system [press release]. Alexandria, VA: American Society of Clinical Oncology; February 12, 2015. new-cms-oncology-care-model-relies-broken-feeservice-system.
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