Here are nine things to know about the OCM.
1. As part of the model, physician group practices have entered into payment arrangements that include financial and performance accountability for all cancer treated with chemotherapy, according to CMS. Episodes last six months each and cover almost all cancer types. CMS is also partnering with commercial payers in the OCM.
2. Nearly 20 payers and 195 practices participate in the OCM.
3. Participating practices include small private practices, large national physician networks, academic medical centers and physicians tied closely to hospitals, according to Managed Care.
4. Among the participating private insurers are:
- Aetna
- Blue Cross Blue Shield of Michigan/Blue Care Network
- Blue Cross and Blue Shield of New Mexico
- Blue Cross and Blue Shield of Oklahoma
- Blue Cross and Blue Shield of Texas
- BlueCross BlueShield of South Carolina
- Capital BlueCross, Inc., Harrisburg, Pa.
- Cigna Life & Health Insurance Company
- EmblemHealth, New York City
- Health Alliance Plan, Urbana, Ill.
- Highmark, Inc., Pittsburgh
- Priority Health, Grand Rapids, Mich.
- SummaCare, Akron, Ohio
- The University of Arizona Health Plans
- UPMC Health Plan, Pittsburgh
- VIVA Health, Birmingham, Ala.
5. Community-based oncology practices in the OCM outnumber participating hospital-employed oncologists or practices that are part of integrated health systems, Lindsay Conway, managing director of research at the Advisory Board, the Washington, D.C., research, technology and consulting company, told Managed Care.
6. Practices participating in the OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation and national treatment guidelines for care, according to CMS.
7. Under the OCM, participating practices must implement six care management requirements, including 24/7 patient access to clinicians, as well as expanded services provided by nurse navigators, according to Managed Care. In exchange, participating practices will receive $160 per Medicare fee-for-service beneficiary per month. This is intended to cover the costs of managing and coordinating care. Under the OCM, physicians are also paid a performance-based incentive, based on the OCM episodes of care.
8. According to Managed Care, the program will also use a number of quality metrice to measure performance. The intention, the report states, is “to prevent practices from inappropriately reducing services to curb expenditures so they come in under their financial benchmarks and to improve patient outcomes.”
9. The five-year model runs through June 30, 2021.
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