The Oncology Care Model: An Overview

The Oncology Care Model (OCM) is an episode-based payment model developed by the Centers for Medicare & Medicaid Services Innovation Center (CMMI) in order to improve the quality of care cancer patients receive at the same or lower cost. According to the National Cancer Institute, “In 2018, an estimated 1,735,350 new cases of cancer [were] diagnosed in the United States and 609,640 people will die from the disease.” In addition, many of those diagnosed are over 65 years old and Medicare beneficiaries, making cancer an even more substantial concern for the federal government. In order to address the individual and societal burdens of cancer in the U.S., the OCM was introduced as a five-year model (2016-2021) in order to test payment strategies designed to produce higher quality care, lower costs, and better outcomes.

OCM participants consist of Medicare-enrolled physician groups, including hospital-based practices. There are currently 175 practices across the U.S. participating in OCM, covering more than 150,000 Medicare beneficiaries. Participants are required to implement “practice redesign activities,” and are incentivized to provide comprehensive, high-quality care that focuses particularly on improving patient experience and outcomes. The Oncology Care Model targets a 6-month window of treatment for cancer patients begins with chemotherapy. Participants must provide “enhanced services,” use data to drive quality improvement, and use certified electronic health record technology (CEHRT). Participants’ performance is assessed using a set of quality measures, including 12 measures which are used to calculate performance-based payments.

The Oncology Care Model is a multi-payer model that includes Medicare fee-for-service (OCM-FFS) as well as Medicare-aligned commercial payers. OCM participants continue to receive regular fee-for-service (FFS) payments during the model, but also uses a two-part payment for participants designed to drive quality improvements and enhanced services including a Monthly Enhanced Oncology Services (MEOS) payment of $160 per-beneficiary for delivery of enhanced services, as well as a performance-based payment for the OCM episode.

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