Special Report: The Oncology Care Model, 10 Years Later

July 1, 2026, will mark 10 years since the start of the Oncology Care Model (OCM), an anniversary that might have seemed less celebratory just a few years ago, but one that is gaining notice, as the influence of the signature model of the Center for Medicare and Medicaid Innovation (CMMI) is felt across cancer care.¹

Signs of the OCM’s impact are everywhere, if you know where to look. Take the recent 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, where leaders from Canopy, developers of remote monitoring technology, demonstrated how connecting patients with their care teams kept them out of the hospital and generated meaningful savings.²

Less than an hour after the Canopy demonstration, researchers presented results showing that prophylactic tocilizumab kept the rate of cytokine release syndrome below 9% when patients with multiple myeloma received teclistamab (Tecvayli; Johnson & Johnson) in community clinics. None of the patients in the trial needed a hospital stay. Notably, the trial has specific check-in and caregiver protocols.³

Both examples involved patient care between appointments, tracking symptoms, and intervening before a slight fever becomes a crisis.

“The focus on whole patient care is and continues to be a great idea,” said Lalan Wilfong, MD, chief medical officer for Navista, the oncology care alliance supported by Cardinal Health. “OCM changed the way we thought about the care outside our 4 walls.”

Before the OCM, innovative practices such as Texas Oncology—where Wilfong was vice president of value-based care and quality programs in 2016, when the OCM launched—had started to connect with patients between visits. However, they relied on the emergency department (ED) or the hospital for costly acute care. The OCM changed all that.

“To be honest, we had no idea what was happening, as we had no information other than Patient X showed up in the [ED],” Wilfong said. “By providing data and incentives, it allowed practices to focus on management to help patients reduce toxicity and more proactively manage issues.”

A decade later, the value of monitoring patients between visits is so compelling that Debra Patt, MD, PhD, MBA, executive vice president of policy and strategy for Texas Oncology, told The American Journal of Managed Care (AJMC) at ASCO that she sees remote therapeutic monitoring becoming part of clinical guidelines, so that practices can bill for it.

“It’s important that you are able to bill for that remote therapy monitoring of patients, because otherwise we can’t continue to provide incremental services for free. That’s hard to sustain,” said Patt, a national leader in technology use in practice. “Guideline formation and payer coverage are things that help transform organizations’ adoption of these tools to serve patients.”

A 2-Part Incentive Structure Looks Better Than the Alternative

The OCM emerged from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which overhauled physician payment by shifting from fee-for-service, or volume, to alternative payment models, or value.⁴ MACRA established the Quality Payment Program, which required physicians and practices taking part in Medicare to enroll in either a payment model tied to their specialty or in the Merit-based Incentive Payment System (MIPS). Many oncologists took a look at MIPS and were not enthused. It wasn’t oncology-specific, and there was widespread belief that the OCM, or something like it, would be mandatory someday. When the OCM launched on July 1, 2016, it had 196 practices, including 3200 physicians in 31 states.⁵

The OCM offered a 2-part payment structure: first, oncology practices received $160 for Monthly Enhanced Oncology Services (MEOS) for each patient under active treatment; second, practices received performance-based payments based on a series of measures for each 6-month period during the program, but the payments and their accompanying data would come well after the end of the performance period. This feedback lag and practices’ ability to know which patients were attributed to them were among the criticisms of the OCM.⁶

Practices that were already employing navigators or piloting payment models with commercial plans were optimistic. “We had the pressures of MACRA and the alternative payment models, and you had the opportunity with OCM to be able to advance what was a potential ‘latest and greatest’ of payment models,” said Ray Page, DO, PhD, FACOI, FASCO, immediate past president and now senior adviser for research at the Center for Cancer and Blood Disorders in the Fort Worth, Texas, area.

“Since we were already doing a lot of those things, it gave us an opportunity to be able to participate, develop, and advance, and hopefully get paid for some of the things that we were already doing,” Page said. “If we performed well, to get some additional value-based payments—all that was a really good fit for our practice to participate.”

But there would be downsides. Wilfong explained that the OCM’s ambition to control a patient’s total cost of care proved unworkable. The MEOS payments, which covered patient navigation, 24/7 access, care planning, and evidence-based care, proved costly to Medicare, as they extended to nearly all patients with cancer regardless of risk level.

Stuart Staggs, MSIE, vice president of transformation and shared services for McKesson, which supports practices in The US Oncology Network, explained how CMMI’s design proved problematic as practices dropped out of the OCM when the time came to transition to full risk—and when the greatest savings would be achieved. To be fair, some smaller practices found stop-loss insurance too costly.⁷ But it was clear in retrospect that others joined OCM with no plan to pursue 2-sided or full risk, which would require repayment of some monies to Medicare if their performance fell short of certain benchmarks.

“With any model, there [are] going to be folks that stick and folks that don’t. You saw the model whittle down to those that were really serious about it, and those that were getting into it went into 2-sided risk,” he said. “The others were like, ‘Yeah, we can’t quite handle that, [but] we want to still participate.’ But I think if 2-sided risk would have taken hold like it should have, at the end of the model without all the other factors, we probably would have seen a better result.”

Mike Fazio, head of value-based care at Navista, is among the few voices in oncology who consistently mention that CMS plans to place all Medicare beneficiaries in accountable care models by 2030. So far, they’re only halfway there, he wrote in an email to AJMC.

“They’ll need to accelerate adoption across specialty care in the coming years to achieve their goal,” Fazio pointed out. “The CMS Long-term Enhanced ACO Design (LEAD) Model goes live January 1, 2027,⁸ and is designed to bring specialty providers more directly into accountable care and give them financial incentives to participate,” including structures for oncologists.

Finally, the OCM seemed snakebit by bad timing. Its underlying formulas were developed when chemotherapy was the standard of care for most patients. But they were implemented at the dawn of the immunotherapyrevolution. CMMI worked to address these challenges, which took time and added to the model’s complexity. Then, in 2020, came the COVID-19 pandemic, which added a year to the OCM’s 5-year schedule just as practices were leaning into 2-sided risk.

The final report on the OCM from Abt Global, issued in May 2024, credited practices for transformation efforts within their control, but centered on the millions in losses. According to the report, “Despite modest reductions in episode payments, OCM resulted in net losses for Medicare exceeding $600 [million], after accounting for MEOS and performance-based payments to participating practices. Net losses were lower in the last 2 years than in prior periods (nearly breaking even in the final performance period).”⁹

The focus on the financial losses—and the resulting overcorrection in the successor, the Enhancing Oncology Model (EOM)—has been a bitter pill for practices that went all in on OCM.¹⁰ From their view, they didn’t design OCM, but they did their best to make it a success. The winners, they say, have been patients, including those not in Medicare, along with payers who continue to see the benefits of practice transformation and ongoing advances in remote digital monitoring.

In the aftermath of the Abt Global report, an October 2024 study led by Samyukta Mullangi, MD, MBA, of Tennessee Oncology and then of Thyme Care, identified “spillover effects” of OCM participation, as these practices almost always extended quality and cost-saving measures to all patients. The OCM was associated with adjusted spending decreases for both high-risk (–$6756) and low-risk episodes (–$4171), the study found. The greatest savings were seen in outpatient and infused/injected anticancer drug spending.¹¹

“The headline was that it didn’t save any money. In fact, it spent more money,” said Johnetta Blakely, MD, MS, MMHC, executive vice president of quality and clinic operations for Tennessee Oncology, who was recently named chief medical officer for the Community Oncology Alliance (COA). “But what they failed to mention was that it really did improve efficiencies. It improved care coordination; again, these were things that a lot of practices had maybe a little bit of, but their programs were not quite as robust as what they ended up being.”

Not only does Blakely see the changes that have occurred and the difference they’ve made, but she is among those who told AJMC that the OCM measures didn’t fully capture what really matters to patients, such as the time it takes to get into treatment.

“We have a whole care coordination team with navigators that we didn’t have [at] this level prior to OCM,” she said. “It’s frustrating, too, because their quality measures were things like hospitalization rates…. And using hospice—well, hospice is great at the end of life, but it is only a surrogate to true quality of care. So, in my mind, they really missed the mark.”

OCM Origins and Achieving Buy-In

The OCM did not arrive in a vacuum. Quite simply, costs across health care were exploding, which was especially true in oncology.

David Wenk, MD, had joined Florida Cancer Specialists & Research Institute (FCS) just a few years before the CMMI announced plans for the OCM. “We

recognized that the current model was not sustainable, and ultimately, that’s what OCM started pivoting to, which is a value-based model. In recognition of that, we said, ‘If the fee-for-service model is going to be something of the past, and we’re going to move to more of a value-based model, we’ve got to start preparing for it,’ ” said Wenk, who is assistant managing physician at FCS.

Like other large practices, FCS was already working on care coordination and team-based approaches. “Because ultimately, how do you lower the costs of cancer care? Well, the drug costs [are] very difficult for us as a practice to do something about, but what we can do is prevent some of the problems that arise from giving care, and that [includes] hospitalizations [and emergency department] visits,” he said.

The concept of whole patient care gained momentum with the oncology patient-centered medical home,¹² most notably through the COME HOME experience, which ran from 2011 to 2015,¹³ led by CEO of New Mexico Oncology Hematology Consultants Barbara L. McAneny, MD, cochair of the ONCare Alliance. The program, which was limited to patients with breast, lung, colorectal, thyroid, or pancreatic cancer; lymphoma; or melanoma, showed that a combination of quality initiatives and care coordination saved 8.1% from anticipated spending compared with the prior 6-month period, while reducing ED visits by 10.2%.¹³

Commercial payers, who were already experimenting with bundled payment models in oncology and other specialties, took notice. UnitedHealthcare (UHC) was among the leading innovators. Led by Lee N. Newcomer, MD, MHA, senior vice president of oncology, genetics, and women’s health, the UHC Episodes of Care program launched in 2009 and expanded in 2015, with a focus on rewarding physicians for “actual results, not work performed,” and on reducing variability in drug costs.¹⁴

CMMI announced plans for the OCM in 2015, on the heels of a similar program in primary care. As Page explained, practices that considered themselves innovators wanted in.¹⁵

“We’re always trying to be on the tip of the spear and ahead of the curve with everything with our comprehensive patient management, so we had already been doing a lot of innovation beyond fee-for-service—treatment pathways, triage pathways, and doing more coordinated care and having navigators, and advanced care planning,” he said. “We already had some relationships with our payers, like [UHC], in an episode of care payment model, so we were already doing a lot of those things.”

The fee-for-service system was under intense scrutiny, and the oncology community was beginning to grapple seriously with the cost and coordination of cancer care.

Texas Oncology’s Susan Escudier, MD, FACP, now vice president of value-based care and quality programs, was not involved with planning for the OCM in its earliest days, but she recalls the atmosphere. “There was a lot of concern about the sustainability of the fee-for-service model and wanting to get experience with working in a value-based environment and developing that skill set,” she said. Texas Oncology’s size and level of discipline as an organization meant a shift to value-based care made sense, if this was coming anyway, she added.

Ted Okon, MBA, COA’s longtime executive director, has similar memories of the period. “We were at the height of the criticism of fee-for-service; the talk of the town, so to speak, was all about value-based arrangements, and this was a big initiative. So, you already had a couple of payers, including [UHC], leading the way of ‘Let’s pay for value,’ and we were all into that. We also believed that when you [ultimately] benchmark progressive practices against the hospital and those facilities, there would be stark differences, and so we said, ‘Bring it on, and let’s see, can we make value-based design work?’”

He added, “We were all for it. It really started out with a bang.”

But benchmarking proved extremely difficult, Wilfong explained, because the science was moving so fast that formulas could not keep up, despite CMS’ efforts to build in adjustments for inflation and drug costs.

In 2015, authors Clough and Kamal had warned in JCO Oncology Practice that innovative practices might encounter issues with OCM: “Practices with historically low costs may find less opportunity to reduce costs and earn performance-based payments but also may require fewer practice changes to meet the requirements for receipt of care management fees.”¹⁵ At the time, CMS was considering whether to reward historically high-performing practices in accountable care organizations, and the authors suggested the OCM might see “a similar evolution.”¹⁵ That did not happen.

For physicians who would go on to shape value-based oncology, the model’s announcement was a galvanizing moment. Stephen Schleicher, MD, MBA, a medical oncologist with Tennessee Oncology and its former chief medical officer, recalls first encountering the intellectual foundations of value-based care during his MBA studies at Harvard Business School, where Michael Porter, PhD—widely credited with coining the term—was developing the concept.¹⁶

“When I went to fellowship at Memorial Sloan Kettering [Cancer Center], the OCM was announced, and I remember being so intrigued that none of my academic mentors, who were the world experts in every disease, knew anything about what the OCM was.”

That gap between clinical expertise and payment innovation, he says, became an obsession that shaped his career. Yet it also represented a source of tension at the practice level, as clinicians who were leaders in their specialties had to accept new ways of doing things.

Escudier remembers the uproar over clinical pathways, for example. “Cookbook medicine,” she said, recalling the derisive label pinned on tools used to reduce variation in care and enforce evidence-based medicine.

But the hardest part was changing doctors’ thinking: that they should consider the effects of their actions beyond the clinic walls.

“For physicians, changing the mindset that we were responsible for the entire patient care and not just their cancer was difficult,” Wilfong said. “They would ask, ‘What if they fell and broke their hip? Why is that my problem?’ I would then ask, ‘Why are you giving chemotherapy to someone who is so weak that they fall and break their hip?’”

Escudier agreed. As with any change, she said, there was a mix of early adopters, “show me” people, and those more resistant to change. In that vein, the move to value-based care involved a mix of education, carrots, and sticks, she said. Early changes focused on ordering less expensive chemotherapy regimens; later, this shifted to biosimilars. Escudier credits the pharmacy for taking charge of identifying which biosimilars are preferred by various health plans; reports also show that Texas Oncology gave pharmacists control over ensuring patients received antiemetics when treated with certain anticancer agents.

“Just getting people to that comfort point, [to understand] that these changes are really carefully thought out to not impact quality of care,” was essential, Escudier said. Physicians were told that the top factor in treatment selection would always be efficacy, followed by toxicity, and then cost.

“What I really learned in my time of being involved in these things is you really need constant communication and constant education of the doctors for change,” Escudier said. She would hear from the pharmacy that a certain physician refused to allow substitutions, and that would lead to a conversation. Physicians were truly busy, and it was unproductive to scold them for ignoring multiple emails and reminders from the pharmacist, she said. In the end, the bonus program that rewarded physicians who followed value-based recommendations proved to be the big motivator.

Wenk said he was truly proud of how well FCS achieved buy-in from its physicians, given the practice’s size and diversity of care settings. “It’s easier to get buy-in when you have 3 people than when you have 300, right?” he said with a laugh. “We were all able to come together as one for the best interest of the patients, and that is hard to do in any industry, especially medicine.”

He added, “And looking back then, even when we were a little bit smaller, we were still pretty large, and we understood that health care was changing, that the traditional fee-for-service model was changing, and it had to change because costs were unsustainable. So, we had to be innovative and think ahead.”

Wenk said FCS also had its mix of early adopters and those set in their ways. The fact that oncology itself is constantly changing helped the cause. “We kept emphasizing that it’s in the best interest of the patient, and as we continued to get around to that goal of patient care, we were able to get buy-in pretty quickly,” he said.

Early Wins and “Aha” Moments

The first years of the OCM were challenging. Practices had to invest in technology and personnel to produce the data needed for reporting requirements and for their own monitoring. To meet the requirement of 24/7 access, multiple practices had to overhaul their phone systems and develop triage protocols so that patient calls did not fall into a black hole. Today, a new wave of investment is occurring as many of these personnel-driven systems are being converted to artificial intelligence (AI).

“The area that most needed adjustment was our clinic workflows to manage patients in between visits,” Wilfong said. “We didn’t have a system to answer the phones, for example, so patients would leave voicemails that went unanswered for hours. We had no mechanism to bring patients into clinic urgently. Changing those processes took years and is still an area of refinement.”

But multiple physicians and experts who spoke with AJMC said that as they chipped away at these issues, they saw signs that cancer care was going to change—in a good way.

“It proved that proof of principle that you could collect more data, or you could analyze other indices, and look at that globally,” said Richard M. Ingram, MD, FASCO, president of Shenandoah Oncology in Winchester, Virginia. Tracking hospitalized patients, conducting root cause analyses, and trying to learn where the oncology practice could make an impact revealed areas for intervention, he said.

“You started to realize that with some proactive management, some common sense, and clinical experience, you could start to see some patterns, so I think that was the ‘aha!’ moment,” Ingram said. “Then, I think when we realized that once you got in the groove of the data collection and the consent process and the treatment plan, the incremental work didn’t feel [as] burdensome as we thought it would, because we actually scaled it across the whole practice,” he said.

Echoing the findings of Mullangi’s 2024 study,¹¹ Ingram noted, “Once we got moving with OCM, we did a care plan on everybody, OCM or not.”

For Page, the “aha” moment came in 2019, when the practice worked with the early health care AI startup Jvion on a system that could risk-stratify which patients needed to be closely monitored and match them with clinical trials.¹⁷

“One thing that we really carried forward… and continue to do today is comprehensive patient management of identifying our most vulnerable patients and making sure that they stay healthy and happy during their journey with cancer,” Page said. “The symptom management triage system has been one thing that we’ve done that has been important.”

As for successes, Escudier includes electronic patient-reported outcomes (ePROs), something she wasn’t convinced would work.

“I think the ePROs were an early win, and I think we were able to replicate the data of the early developers that [showed] it did improve patient outcomes,” she said. “I will say, I was one of the skeptics. I thought, ‘Oh my God, if I have to listen to everybody’s complaint about everything, that’s all I’m going to do all day long.’ But we found that patients engaged in different ways. [Older] patients tended to use it to get information; younger patients tended to use it to have a diary of their symptoms and the things that were going on with them. Once we figured out that we only needed to address the higher acuity complaints, and that the patient can also check ‘No need for a call,’…I think that was helpful.”

Math, Measurement, and “the Secret Sauce”

Fall 2019 was a crucial period. Practices in the OCM faced a December 3, 2019, deadline to decide whether to stay with 1-sided risk or move into 2-sided or full risk.

In early February 2020, COA conducted a survey that found 37% of practices in the model chose 2-sided risk, with 16% of practices dropping out.¹⁸ There was an option that allowed practices with at least 1 performance-based bonus payment to stay in 1-sided risk, but practices without bonus payments had to accept 2-sided risk or leave.

But CMMI was not the only judge of the OCM. External evaluations of the OCM began appearing, and some were not pleasant. An article on the first performance period, published in JCO Oncology Practice, noted “modest program-related impacts on some acute care services, and no change in total episode payments.”¹⁹ The authors acknowledged that more redesign efforts might be coming.

Even as it worked with CMMI, COA felt compelled to publicly critique methodological flaws in the model, given its complexity and financial impact on its member practices.²⁰

Practices were feeling the effects of soaring immunotherapy costs, as seen in a June 2018 exchange at the NCCN Policy Forum. Ron Kline, MD, then medical officer for CMMI’s Patient Care Models Group, confirmed that the looming costs of chimeric antigen receptor T-cell therapy, priced at $475,000 per dose, would be excluded from total cost-of-care calculations. But he also said that the OCM was not designed to be easy. He noted that early data showed 25% of practices cut costs by 7%, and “60% of practices decreased costs, compared with the baseline.”

Staggs described this as the “hump” problem: In the early years of the OCM, costs kept rising because of the unanticipated impact of immunotherapy; the OCM’s trend factor was supposed to mimic this, but it couldn’t keep up. Later, practices became savvier about using biosimilars to cut costs and got over the “hump” as costs began to decline.

This offered a double benefit to practices that stuck it out, because as the immunotherapy adoption curve matured, these drugs became standard of care rather than novel add-ons. The pandemic, of course, was a wild card, one that ultimately allowed practices to escape penalties because, Staggs noted, “CMS allowed practices to opt out of downside risk.” This helped practices, but it eroded Medicare savings.

In 2021, Kline, Wilfong, and other well-known OCM figures including Sibel Blau, MD, president of Northwest Medical Specialties, PLLC, published “Secret Sauce: How Diverse Practices Succeed in Centers for Medicare & Medicaid Services Oncology Care Model” in JCO Oncology Practice. They concluded, “There is no one thing that will ensure success in the OCM,” but added that key elements include changes in physician compensation, physician champions, care coordination, phone triage, clinical pathways, and end-of-life care programs. “Changes in practice culture,” they wrote, are important to success.²¹

Other evaluations began to flow in. Nancy L. Keating, MD, MPH, of Harvard Medical School, in examining data from the first 3 performance periods, coauthored a paper that showed the OCM had “no significant association with chemotherapy-associated hospitalizations but was associated with a statistically significant relative decrease in the proportion of episodes with a chemotherapy-associated ED visit.” The researchers found no association with the timeliness of adjuvant therapy following surgery for breast or colorectal cancer, chemotherapy within the last 14 days of life, the occurrence of 2 or more ED visits in the last 30 days of life, or hospice enrollment or timing.

However, the model was associated with a statistically significant decrease in the proportion of beneficiaries hospitalized in the last 30 days of life and less spending on supportive care therapy.²²

Once again, physicians working the model day to day insisted that the feedback lag meant the findings did not reflect what they were seeing in practice. Having remote monitoring and better triage systems had been critical during the pandemic, they noted. The emphasis on pharmacy operations enabled some practices to establish home delivery services for medication, which CMS later shut down after the health emergency ended.

A new team was now in charge at CMS, and the OCM was set to expire on June 30, 2022.

Enter the EOM—and a Fresh Look at What the OCM Achieved

CMS waited until June 27, 2022, days before the OCM expiration date, to announce that the OCM would be replaced with the Enhancing Oncology Model (EOM), which has structural similarities to the OCM. The EOM, which started July 1, 2023, and ends June 30, 2030, provides less revenue, covers only 7 cancers, and offers a narrower operating path. Beyond initially reducing MEOS payments from $160 to $70 per patient per month, the model offered a narrower “safe zone” for meeting performance targets. It required practices to take on full risk from the outset.¹⁰

The original model had robust requirements for achieving health equity goals, but those have been shelved as part of the Trump administration’s broader policy of removing equity initiatives.

After the yearlong gap between the 2 models, 44 practices signed on to the EOM. Feedback from the first performance period was uneventful, but in August 2025, many practices found their data impossible to explain—along with CMMI’s decision to post results online. Blau, who also cochairs the ONCare Alliance, described the years of effort she had put into value-based care. “Now where does it put me?” she asked during the COA Payer Exchange Summit in September 2025. “I want to do this, I want to learn, I want to adapt, but we’ve already done other great things, and I’m doubting this whole decision,” to sign on to the EOM.²³

At press time, 28 practices are part of the EOM; at the end of the OCM, there were 122 participants.^5,10 Stalwarts of value-based care, from Blau’s practice to Tennessee Oncology, have left the model, but their transformation efforts go on.

Fazio sees 2 problems with the EOM enrollment strategy. In his email, he noted that giving practices a risk-free period to learn the EOM—or any model—helps build trust in the Medicare model design and “will go far in driving increased participation.” Second, the ongoing inability of Medicare to provide practices with data for patients in active treatment is a problem. Using a channel such as Data at the Point of Care, which CMS is piloting, “will support practices with more actionable data that is relevant to any model they’re operating,” he added.

This spring, as the 10-year milestone approached, the OCM received some second looks in light of information now available and where cancer delivery is today. Just this month, Keating and coauthors published an update that included data from the period immediately post OCM that showed Medicare losses had been cut in half, based on the performance of practices that took on full risk.²⁴ And Keating led another paper that highlighted a flaw in the model: For a program that purported to promote savings, it lacked a method to measure what physicians did not do. “By not examining changes in chemotherapy initiation, the OCM evaluation may have underestimated savings related to the model,” the authors wrote.²⁵

In his interview with AJMC, Ingram highlighted this point. “If I see someone who’s EOM or OCM eligible—let’s say for stage IV lung cancer—and I don’t treat them if their performance status is borderline, but I do take care of them—and get them into palliative care and hospice, and they have a fulfilled life, then that patient’s never in the model. And I probably bent the cost curve by avoiding toxicity and avoiding cost,” he said. “That same patient you take care of for several episodes drops out of the model as soon as they stop taking treatment—so you’re not really looking at the continuum of care. There are some glaring holes in the model.”

Taking note of all this, Mullangi and Schleicher joined Ravi B. Parikh, MD, for an editorial in JAMA this spring.²⁶ They wrote the following: “Strikingly, savings grew over time, reaching –$1282 per episode in the final performance period, roughly quadrupling the –$297 per-episode reduction reported in the interim 3-year evaluation. Yet the headline will be the net loss to Medicare: Between MEOS payments and performance-based payments, the program paid out $639 million more than it gained in spending reductions over 6 years. This framing that growing spending reductions were insufficient to offset program payments has already shaped policy.”

Noting the low uptake of the EOM, which aimed to correct OCM losses, they asked, “Did CMS learn the right lessons from the OCM, or did a premature reading of the evidence produce a struggling successor model that may forfeit the gains the OCM was beginning to achieve?”²⁶

In the interview with AJMC, Schleicher said the model had challenges to be sure: Case mix is “always an issue” in a model that aims to reduce spending when drugs are the most expensive part. “The OCM, I have no doubt, was good for oncology. Because the OCM existed, it changed how people think,” he said.

Across a dozen interviews, the focus on the whole patient drew the greatest consensus on what to keep if starting an oncology payment model today. Shiela Plasencia, director of practice support for COA, offered these thoughts:

“If I [were] building a new model today, I would retain the care delivery infrastructure and episode-based framework, but tighten incentives, simplify operations, and modernize measurement. The OCM was inclusive of most cancer types, making it easier to provide this level of care for all of our patients, not only those in a particular value-based model or arrangement.”

Okon has seen government programs come and go. His frustration is visible when he talks about how OCM expired, only to be replaced by a withering, unworkable model.

He knows that 10 years ago, a patient with cancer experiencing dehydration would go to the ED without a second thought. “It cost an arm and a leg,” Okon said. To drive change, “practices did some really novel things. And make no mistake—and this is the exasperating thing when we look at where the OCM has gone or hasn’t gone—this was landmark. This was amazing.”

Okon concluded, “The government, which always lags behind, basically took the reins and introduced this—and it really pushed private payers to do the same thing. I don’t know of many cases like this, where the government was at the forefront and actually turned behavior…. If you look at what practices do now, it’s a different mindset. They do 24/7; they do hydration on weekends.

“It changed physician behavior to thinking about the ramifications for the patient.”

References

1. Oncology Care Model. CMS website. Accessed June 3, 2026. https://www.cms.gov/priorities/innovation/innovation-models/oncology-care
2. Essell J, Derman BA, Kolodziej MA, et al. Impact of remote therapeutic monitoring with patient-reported outcomes on hospitalization in real-world patients receiving therapy for metastatic solid tumors. J Clin Oncol. 2026;44(suppl 16):11005. doi:10.1200/JCO.2026.44.16_suppl.11005
3. Forsberg P, Andorsky D, Rifkin RM, et al. Optec/Optal: a phase 2 study to evaluate outpatient (OP), step-up administration of teclistamab (Tec) or talquetamab (Tal) with prophylactic tocilizumab (prophyToci) in patients (pts) with relapsed/refractory multiple myeloma (RRMM). J Clin Oncol. 2026;44(suppl 16):7510. doi:10.1200/JCO.2026.44.16_suppl.7510
4. MACRA. CMS.gov. Updated September 10, 2024. Accessed June 3, 2026. https://www.cms.gov/medicare/quality/value-based-programs/chip-reauthorization-act
5. Oncology Care Model. Foley Hoag. July 1, 2016. Accessed June 3, 2026. https://foleyhoag.com/news-and-insights/publications/alerts-and-updates/2016/july/oncology-care-model/
6. Caffrey M. OCM successor puts focus on equity in cancer care—with fewer dollars for services. Am J Manag Care. 2022;28(spec 6):SP403.
7. Bennett C. OCM practices take on two-sided risk but uncertainty looms. Oncology News Central. January 14, 2020. Accessed June 3, 2026. https://www.oncologynewscentral.com/article/ocm-practices-take-on-two-sided-risk-but-uncertainty-looms
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