The Oncology Care Model
What is the Oncology Care Model (OCM)?
The Oncology Care Model (OCM) is an innovative payment model for physician practices that are Medicare providers administering chemotherapy. OCM’s main goal is to utilize appropriately aligned financial incentives to improve care coordination, appropriateness of care and access for beneficiaries undergoing chemotherapy.
The OCM offers two forms of payment for practices: a monthly per-beneficiary-per-month (PBPM) payment for the duration of the episode of care, and a potential performance-based payment for episodes of chemotherapy care.
Practices that participate in the OCM PBPM program will receive $160 per beneficiary per month to assist in managing and coordinating care for oncology patients during episodes of care. The performance-based payment will incentivize practices to lower the total cost of care and improve the quality of the care delivered to patients during their episodes of treatment.
TYPES OF PARTICIPANTS
Medicare beneficiaries who meet each of the following criteria will be included in the fee-for-service portion of OCM:
Eligible for Medicare Part A and enrolled in Medicare Part B
Have Medicare FFS as their primary payer
Do not have end-stage renal disease
Are not covered under United Mine Workers
- Receive an included chemotherapy treatment for cancer under management of an OCM participating practice
OCM fee-for-service includes nearly all cancer types and all non-topical chemotherapy. Episodes initiate when a beneficiary starts chemotherapy. Included services are all Medicare A and B services that Medicare FFS beneficiaries receive during episodes of care, as well as certain Part D expenditures. Episodes extend to six months after beneficiaries start chemotherapy. Beneficiaries may initiate multiple episodes during the five-year model performance period.
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WHAT ARE your PRACTICE REQUIREMENTS to participate IN THE OCM PROGRAM?
Providing 24/7 patient access to an appropriate clinician who has real-time access to a patient’s medical records
Using an ONC-certified EHR and attest of Stage 2 of meaningful use (MU) by the end of the third model performance year
Utilizing data for continuous quality improvement
Providing core functions of patient navigation
Documenting a care plan for every OCM patient that contains the 13 components in the Institute of Medicine Care Management Plan
- Treating patients with therapies consistent with nationally recognized clinical guidelines
WHAT ARE THE PAYOR REQUIREMENTS?
OCM covers Medicare fee-for-service payors and other payors, including commercial payors, state Medicaid agencies, or other governmental payors. Requirements for Payors participating in the OCM program are:
Commit to participating in the OCM program for 5 years, and beginning their performance period within 90 days of OCM fee-for-service’s performance period.
Sign a Memorandum of Understanding with the CMS Innovation Center
Enter into agreements with OCM practices that include requirements to provide high quality care
Share model methodologies with CMS Innovation Center
Provide payments to practices for enhanced services and performance as described in the RFA
Quality Improvement Measures
Align practice quality and performance measures with OCM, when possible
- Aggregate and provide patient-level data about payment and utilization for their patients receiving care in OCM, at regular intervals
MONITORING AND EVALUATION OF OCM FEE-FOR-SERVICE PRACTICES
Participant monitoring activities may include:
Tracking of claims data
Analysis of quality measurement data
Time and motion studies
- Medical record audits, tracking of patient complaints, and appeals