HealthLoop Oncology Care Model
OCM

What is the Oncology Care Model (OCM)?

CMS announced a new payment and delivery model designed to improve the effectiveness and efficiency of specialty care for patients undergoing chemotherapy. The Oncology Care Model (OCM) aims to provide higher quality and more coordinated oncology care at the same or lower cost, resulting in better care, smarter spending and improved health for many of the 1.6 million people diagnosed with cancer each year in the U.S. Under the OCM, physician practices have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to patients with cancer. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation and national treatment guidelines for care.

CMS will provide a learning system for participants to share and diffuse resources, tools, ideas and data-driven approaches to care. This system will include webinars, an online portal to share resources, action groups, site visits and coaching.

 

 

View a Map VIEW THE MAP of participating oncology services providers participating in the OCM.

Participation

HHS selected 17 payers and 196 physician practices to participate — almost twice the number it expected.

Episodes of care last six months each and cover almost all cancer types. The episode starts when the patient starts chemotherapy. It will include all Medicare Part A and B services, as well as some Part D expenditures. If beneficiaries need more chemotherapy after the end of the six-month period, they begin a new episode. If they enter hospice care, the payments are discontinued.

Practices can receive a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the duration of the treatment episode and the potential to receive a performance-based payment for episodes of chemotherapy care. The $160 MEOS payment assists participating practices in effectively managing and coordinating care for their oncology patients. The performance-based payment incentivizes practices to lower the total cost of care and improve care for beneficiaries during treatment episodes and will be awarded in addition to the MEOS payment if specific criteria are met.

In addition to Medicare fee-for-service, the model includes state Medicaid agencies and commercial payers that are able to design their own payment incentives if they align with the Innovation Center’s goals of care improvement and efficiency.

Dual participation in OCM and other programs is allowed in some cases. Practices can participate in shared savings programs like accountable care organizations (ACOs) or the Comprehensive Primary Care model; however, dual participation in OCM and the Transforming Clinical Practice Initiative is not allowed.

VIEW THE MAP of participating oncology services providers participating in the OCM.

Oncology Care Model

 

The 17 Participating Commercial Payers

  1. Aetna
  2. Blue Cross Blue Shield of Michigan/Blue Care Network
  3. Blue Cross Blue Shield of New Mexico
  4. Blue Cross Blue Shield of Oklahoma
  5. Blue Cross Blue Shield of Texas
  6. BlueCross BlueShield of South Carolina
  7. Capital BlueCross, Inc.
  8. Cigna Life & Health Insurance Company
  1. EmblemHealth
  2. Health AlHealthPartners, Inc.
  3. Health Alliance Plan
  4. Highmark, Inc.
  5. Priority Health
  6. SummaCare
  7. The University of Arizona Health Plans
  8. UPMC Health Plan
  9. VIVA Health, Inc.

 

Helpful Links

CMS Initiatives: Oncology Care
https://innovation.cms.gov/initiatives/oncology-care/

Additional Information