New Oncology Care Model Focuses on Payment Reform and Value-Based Care

Jessica Miller

July 2016, Vol 7, No 6 - Health Policy

A new payment and delivery model introduced by the Center for Medicare & Medicaid Innovation aims to align financial incentives to improve oncology care and outcomes. Expected to begin in July 2016, the program will target patients from the start of their chemotherapy through 6 months of care.

Practices that are participating in the program will be required to:

  • Provide patient navigation
  • Document a care plan
  • Have a clinician with access to current medical records available to patients 24 hours a day, 7 days a week
  • Utilize nationally recognized clinical treatment guidelines
  • Monitor data to improve quality
  • Use an electronic health record that is certified by the Office of the National Coordinator for Health Information Technology.
The multipayer model will include Medicare fee for service and will use a 2-part payment approach that includes a care management payment of $160 per beneficiary per month and a performance-based payment for episodes of care.

The new model will require a change in the way practices think about healthcare delivery. Patients and their family will be the center of care, with activities designed around what is most efficacious for them instead of healthcare revolving around the provider and the care facility, explained Diana K. Verrilli, MS, Vice President and General Manager, Payer & Provider Solutions, McKesson Specialty Health. In collaboration with the US Oncology Network, McKesson Specialty Health sponsored a project to design and pilot the needed care delivery changes to meet the requirements of the Oncology Care Model (OCM).

“This new model…is a change not only for physicians, but the entire spectrum of how we deliver outpatient care, from proactive nursing calls and education of patients to how the back office bills visits to quality and performance improvement with measure and continued redesign of care,” she said.

According to Ms Verrilli, the OCM has the potential to decrease healthcare costs while improving patient-reported outcomes. “We can look at a Health Policy Brief published by the Institute of Medicine in 2012 [Cafarella Lallemand N. Health Aff. December 13, 2012] that suggested up to 30% of [Medicare] healthcare [spending] may be wasteful, citing failures in care delivery, failure of care coordination, unhelpful overtreatment, administrative complexity, pricing failures, and fraud and abuse,” she said. The OCM program’s design specifically addresses a number of these areas, including care delivery and care coordination, pushing practices to focus on improving them.

Success will be measured in a number of ways, according to Ms Verrilli, including chemotherapy prescribed in accordance with national standards and guidelines, patient-reported outcomes of symptoms, the total cost of care per episode, and important outcome measures, such as survival and end-of-life measures.

To help practices better succeed, McKesson recently held an intensive 2-day training program for personnel from practices within the US Oncology Network that will be participating in the OCM. Using data and experiences from 3 pilot sites that tested McKesson Specialty Health’s comprehensive OCM solutions, attendees at the training program were able to learn more about what is needed to successfully transition to the OCM program.