Oncology Care Model Practices Announced

This post was written by Jessica Turgon, Principal, Matt Sturm, Senior Manager, and Meagan O’Neill, Senior Consultant.

Earlier this week the Centers for Medicare & Medicaid Services (CMS) announced the nearly 200 organizations that have been selected for participation in the Oncology Care Model (OCM), one of the new payment and care delivery initiatives introduced by the Center for Medicare & Medicaid Innovation (CMMI) in 2015. The 5-year pilot is slated to begin July 1, and according to CMS, the number of participants is twice the size as initially anticipated – it will include approximately 3,200 oncologists and provide coverage for 155,000 Medicare beneficiaries. Continue reading

Five Keys to Success Under the Oncology Care Model

In January 2016, the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare and Medicaid Innovation (CMMI) announced a new value-based payment program for oncology practices and centers. The Oncology Care Model (OCM) is an alternative payment model (APM) that CMS is testing over a 5-year period to evaluate the shift in oncology payments from fee-for-service to fee-for-value. Continue reading

Oncology Medical Homes: Patient-Centered Care in the Specialty Realm

One of the foremost objectives of a patient-centered medical home (PCMH) is to reduce unnecessary specialty visits through effective management of acute and chronic illnesses. Invariably, though, some conditions require more costly specialty care. Among these conditions, cancer is notable for the extent to which it becomes the primary medical focus immediately upon diagnosis and establishes the context in which all other conditions must be managed. In that sense, PCMHs face particular challenges in managing patients with cancer, because much of their care transitions to specialists and settings that do not share the PCMH’s incentives for coordination, integration, and cost containment. Continue reading

The Changing World of Oncology Reimbursement – Are You Ready?

The expenses associated with cancer care in the United States are staggering and only expected to climb.  In 2010, the total cost was $125 billion.  By 2020, with more individuals living with cancer as a chronic disease, costs are expected to grow by 36% and exceed $170 billion.  Faced with escalating costs, the government, payors, and providers are engaging in various activities to test different reimbursement methodologies for cancer care. Continue reading