CMS Announces Practices and Payers Participating in the OCM

CMS has announced that the Oncology Care Model (OCM) developed by the Center for Medicare and Medicaid Innovation has 196 practices and 17 payers enrolled for participation.

The Oncology Care Model (OCM) developed by the Center for Medicare and Medicaid Innovation (CMMI) has 196 practices and 17 payers enrolled for participation, CMS announced earlier today. The OCM, a 5-year model that begins on July 1, 2016, and runs through June 30, 2021, is focused on providing better, more coordinated care.

The OCM is a value-based model that includes financial and performance accountability for episodes of care for chemotherapy administration in patients with cancer, with the objective of improving care while lowering costs. Shared decision-making with patients is encouraged under the OCM, and physicians are provided an incentive to comprehensively address the complex care needs of patients receiving chemotherapy, while improving outcomes.

Participation of commercial payers is an added incentive for practices to participate in the model. Aligned financial incentives among commercial health plans and CMS will help the model reach a much broader population of patients. Additionally, payers will have the flexibility to design their own payment incentives for providers while aligning with CMMIs goals of care.

With a 6-month episode that begins with chemotherapy, participating practices are expected to:

  • Provide enhanced services, including: The core functions of patient navigation A care plan that contains the 13 components in the Institute of Medicine Care Management Plan outlined in the Institute of Medicine report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis” Patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to practice’s medical records Treatment with therapies consistent with nationally recognized clinical guidelines
  • Use data to drive continuous quality improvement.
  • Use certified electronic health record technology

The 2 part payment system under OCM includes a per-beneficiary Monthly Enhanced Oncology Service payment for the duration of the episode, which is set at $160. There is also the potential for a performance-based payment for episodes of chemotherapy care, an incentive to lower total costs and improve care rendered during a defined episode.