Experts Discuss Medicare’s New Oncology Care Model

The CMS Innovation center (CMMI) recently announced the development of a new payment and delivery model to improve the effectiveness and efficiency of specialty healthcare. The new Oncology Care Model (OCM)1 one of several models being developed by CMMI requires participating physician practices that administer chemotherapy to enter into payment agreements with CMS to measure financial and performance accountability for episodes of care. Incentives in OCM include a monthly per beneficiary-per month (PBPM) payment of $160 for the entire duration of the episode, along with the possibility of a performance-based payment to foster quality care at a lower cost during the episode. CMS hopes to encourage participation by private payers, which would allow for a multipayer model to incentivize care transformation at the physician practices.

To discuss OCM and other issues in oncology care, The American Journal of Managed Care conducted the Oncology Stakeholders Summit, Spring 2015 Peer Exchange. From community oncology, to health policy, to health plans, the Summit brought diverse expertise together. The moderator of the panel, Bruce Feinberg, MD, vice president and chief medical officer of Cardinal Health Specialty Solutions, was joined by Scott Gottlieb, MD, resident fellow at the American Enterprise Institute (AEI); Brian Kiss, MD, vice president of Healthcare Transformation at Blue Cross Blue Shield (BCBS) of Florida; Michael Kolodziej, national medical director for Oncology Strategy at Aetna; and Ted Okon, MBA, executive director of Community Oncology Alliance (COA). Gottlieb, currently at AEI, has performed various roles at the FDA, including deputy commissioner for medical and scientific affairs, and has also served as a senior policy advisor for CMS.