Nearly 200 oncology practices and 17 private payers jumped aboard the Oncology Care Model (OCM), a five-year multipayer program launched by CMS’s Center for Medicare & Medicaid Innovation (CMMI) last July. One of the federal government’s first physician-led specialty care models, the OCM attracted many more practices than the Innovation Center originally envisioned, suggesting that oncologists liked the government’s offer.
So will the OCM become the standard way to pay for cancer care in the future?
That’s the consensus of five individuals who have spent the past decade searching for a better way to pay for oncology services.
In addition to episode payments that cover Medicare Part A and B costs, the OCM is paying participating oncology practices $160 per beneficiary per month for care coordination and extra services, such as round-the-clock access to a clinician. The oncology practices can bill for multiple episodes for a single patient. And the shared savings provisions include one- and two-sided risk.
“I think that the OCM represents a transitional model,” says Michael Kolodziej, MD, national medical director for managed care strategy at Flatiron Health.
John Sprandio, MD, chief physician at Consultants in Medical Oncology and Hematology in Broomall, Pa., just outside Philadelphia, calls the OCM “a step in the right direction” because it gives practices and payers an opportunity to learn about value-based contracts. “It’s not perfect—there will be adjustments and modifications in terms of understanding what the real levers are in controlling the total cost of care,” he says.
At the Advisory Board, managing director Lindsay Conway also anticipates changes. “By no means have we seen the ultimate ideal payment arrangement that will sustain cancer care indefinitely in the future,” she says.
“I think [the Oncology Care Model] is a really good program for the providers,” says Lili Brillstein of Horizon Blue Cross and Blue Shield in New Jersey.
Horizon Blue Cross and Blue Shield in New Jersey elected not to participate in the OCM. Lili Brillstein, director of the insurer’s New Models and Episodes of Care program, says Horizon already has its own bundled payment program, which pays practices retrospectively, unlike the OCM. But she has encouraged the oncology practices in her network to participate: “I think it’s a really good program for the providers,” she says.
Not really, says Barbara McAneny, MD, chief executive officer of New Mexico Cancer Center in Albuquerque. Based on her experience with the CMMI-supported COME HOME program, McAneny says the OCM gives practices too little upfront payment, too little support, and too little time to make the changes to their practices needed to thrive under the payment model.
“I am very committed to the idea that it needs to succeed,” she says. “But I’m also a realist, and I know what practices can and can’t do.”