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

 

EPISODE DEFINITION

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?

  1. Providing 24/7 patient access to an appropriate clinician who has real-time access to a patient’s medical records

  2. Using an ONC-certified EHR and attest of Stage 2 of meaningful use (MU) by the end of the third model performance year

  3. Utilizing data for continuous quality improvement

  4. Providing core functions of patient navigation

  5. Documenting a care plan for every OCM patient that contains the 13 components in the Institute of Medicine Care Management Plan

  6. 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:

  • Operational

    • 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

  • Data Sharing

    • 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

  • Patient surveys

  • Site visits

  • Analysis of quality measurement data

  • Time and motion studies

  • Medical record audits, tracking of patient complaints, and appeals

CMS recommends the use of technology for OCM compliance.

Here is how verbalcare can help you: 

Register below to LEARN ABOUT HOW VERBALCARE CAN BE YOUR TECHNOLOGY SOLUTION FOR OCM.

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