They call it the cancer tsunami – a super wave of disease that is estimated to have a $100 billion-plus impact. And it’s only going to grow as baby boomers age. The answer from the U.S. Centers for Medicare and Medicaid Service (CMS) is the Oncology Care Model. CMS recently announced the final list of nearly 200 physician practices and nearly 20 payors that are participating in this innovative new approach. This looks like a major milestone in the evolution toward value-based payment models.
According to Patrick Conway, M.D., chief medical officer and principal deputy administrator of CMS, care coordination has an important role to play in bringing down costs and boosting quality:
“It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care. 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 fact, CMS is asking participants to provide a number of “enhanced services” to cancer patients during the five-year effort:
- Care coordination
- 24/7 access to care
- Ensuring that test results are received prior to appointments
- Patient support resources, such as emotional support groups and pain management/palliative services
As you can see, the focus is very much on increased collaboration and information sharing among different providers. There will be considerable emphasis on the details, such as scheduling follow-up appointments in advance and diagnostic test times for physicians participating in the Oncology Care Model. We have discussed the importance of care coordination to the Oncology Care Model. We also believe such coordination is critical for solving dangerous communication problems in other specialties and across the healthcare industry generally.
These services are being funded through a $160-per-beneficiary monthly payment. Participating doctors can also earn performance-based payments based on fulfilling quality measures and reducing expenditures below pre-determined targets. According to CMS, “the financial incentives from the program are meant to bring more focus toward care coordination and appropriateness of care.” The program will focus on Medicare beneficiaries who receive chemotherapy, along with the spectrum of services in the six months following that initial treatment.It’s important to note how other government initiatives in cancer care – such as the NIH’s program on rehabilitation care – can complement CMS’ Oncology Care Model.