Centers for Medicare & Medicaid Services' Oncology Care Model: Delivering Higher Value Cancer Care

2017 ◽  
Vol 101 (5) ◽  
pp. 569-571 ◽  
Author(s):  
LK Mortimer ◽  
LM Strawbridge ◽  
EW Lukens ◽  
A Bassano ◽  
PH Conway ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Model ◽  
Oncology Care

Quantifying episode-based costs of care under the oncology care model: Analysis of Medicare beneficiaries in the UAB cancer community network.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 19-19
Author(s):  
Courtney Williams ◽  
Andres Azuero ◽  
Maria Pisu ◽  
Karina I. Halilova ◽  
Warner King Huh ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cancer Drug ◽  
First Episode ◽  
Administrative Claims ◽  
Care Model ◽  
Community Network ◽  
Costs Of Care ◽  
Anti Cancer ◽  
Episodes Of Care ◽  
Oncology Care

19 Background: The Oncology Care Model (OCM) is a specialty care model developed by the Centers for Medicare & Medicaid (CMS) Innovation Center aimed at providing higher quality, more highly coordinated cancer care and reducing costs for patients undergoing chemotherapy. The OCM calculates costs of care in a novel way by anchoring costs within episodes of care, defined as six-month intervals triggered by initial anti-cancer treatment, as opposed to diagnosis date. The purpose of this study is to assess costs within the OCM episodes of care. Methods: This was a secondary analysis of Medicare administrative claims data for beneficiaries 65 and older with cancer who received anti-cancer drug treatment (chemotherapy, hormone therapy) between 2012-2015 at an institution in the UAB Cancer Community Network (CCN). Total and service-specific costs (Medicare reimbursement to providers) per patient-episode were summed from inpatient, outpatient, chemotherapy, radiation therapy, testing/pathology, evaluation and management (E/M), home health, skilled nursing facility (SNF), and hospice claims. Prescription drug costs were not included. Mean costs for the first three OCM episodes were calculated and compared to (1) diagnosis-based costs (six-month intervals starting at cancer diagnosis) and (2) service type. Results: Average total cost in the first three OCM episodes of care was $24,922 (n=13,902), $18,534 (n=6,618), and $16,548 (n=4,672). Compared to episode-based cost, average total diagnosis-based cost was higher in the first episode of care ($33,244, n=9,615), and lower in the second and third episodes ($17,143, n=9,110; $12,897, n=8,002). Episode-based outpatient, inpatient, and chemotherapy costs were the highest service-specific costs in all three episodes of care (1st: $8,374, $5,493, $2,445; 2nd: $6,188, $3,913, $3,158; 3rd: $5,909, $3,251, $3,399). Conclusions: Costly chemotherapy and inpatient and outpatient visits indicate an opportunity for targeted improvement resulting in higher value care. Knowledge of current costs of care will aid oncology practices in transition to the OCM and in usage of value-based services for better quality cancer care.

Sustaining the gains in cancer care from the oncology care model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6632-6632
Author(s):  
Valerie P Csik ◽  
Jared Minetola ◽  
Andrew E. Chapman ◽  
Neal Flomenberg
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
The United States ◽  
Demonstration Project ◽  
Cancer Center ◽  
Care Model ◽  
Drug Expenditures ◽  
Oncology Care ◽  
Ed Visits ◽  
Feedback Data

6632 Background: The Oncology Care Model (OCM) is a 5-year demonstration project led by the Centers for Medicare and Medicaid Services (CMS) to create a framework for the future of oncology care in the United States. More than half way through the project, our large, urban NCI-designated cancer center chose to focus on and invest in resources and personnel for patient navigation and the development of clinical pathways. Although navigation has shown to reduce emergency department (ED) visits by as much as 6% per quarter compared to non-navigated patients, sustaining it is a challenge because it is a nonbillable service. Clinical pathways are a tool to reduce care variation by addressing drug expenditures, and represent an opportunity to reduce outpatient costs by as much as 35% when patients are treated on pathway.3 Many OCM practices made similar investments and all are facing the question: How will the infrastructure and efforts developed during OCM be sustainable after the demonstration project ends? Methods: An analysis of average ED cost and utilization as well as drug expenditures was conducted using OCM feedback data (Q1-Q8). Total utilization of ED visits and ED admits were used to determine a projected annualized cost which was compared to a budgeted navigation team. Similarly, projected annualized drug expenditures were compared to the annual cost of the pathways tool. Results: We found that ED visits and ED admits would need to be reduced by 11% to cover navigation costs. Similarly, a 0.7% reduction in total drug expenditures would cover the cost of clinical pathways. The OCM data represents a timeframe prior to implementation of these programs and an average increase of 1.6% per quarter for ED admits, a 0.6% decrease in ED visits and 2.7% increase in drug expenditures. This will serve as a baseline to measure progress towards our sustainability targets. Conclusions: Long term sustainability of the infrastructure developed during OCM to support cancer care transformation will be dependent on reducing high cost and highly utilized services. Aligning impact areas with resources/tools to ensure sustainability is an approach that can help define targets for OCM practices.

scholarly journals Share of Oncology Versus Nononcology Spending in Episodes Defined by the Centers for Medicare & Medicaid Services Oncology Care Model

2018 ◽  
Vol 14 (11) ◽  
pp. e699-e710 ◽  
Author(s):  
James R. Baumgardner ◽  
Ahva Shahabi ◽  
Mark T. Linthicum ◽  
Christopher Zacker ◽  
Darius N. Lakdawalla
Keyword(s):  
Lung Cancer ◽  
Drug Therapy ◽  
Chronic Myeloid Leukemia ◽  
Cancer Care ◽  
Myeloid Leukemia ◽  
Small Cell ◽  
Care Model ◽  
Small Cell Lung ◽  
Oncology Care ◽  
Oncology Providers

Purpose: Performance-based payments to oncology providers participating in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) are based, in part, on overall spending in 6-month episodes of care, including spending unrelated to oncology care. The amount of spending likely to occur outside of oncologists’ purview is unknown. Methods: Following the OCM definition of an episode, we used SEER-Medicare data from 2006 to 2013 to identify episodes of cancer care for the following diagnoses: breast cancer (BC), non–small-cell lung cancer, renal cell carcinoma, multiple myeloma (MM), and chronic myeloid leukemia. Claims were categorized by service type and, separately, whether the content fell within the purview of oncology providers (classified as oncology, with all other claims nononcology). We calculated the shares of episode spending attributable to oncology versus nononcology services. Results: The percentage of oncology spending within OCM episodes ranged from 62.4% in BC to 85.5% in MM. The largest source of oncology spending was antineoplastic drug therapy, ranging from 21.8% of total episode spending in BC to 67.6% in chronic myeloid leukemia. The largest source of nononcology spending was acute hospitalization and inpatient physician costs, ranging from 6.6% of overall spending for MM to 10.4% for non–small-cell lung cancer; inpatient oncology spending contributed roughly similar shares to overall spending. Conclusion: Most spending in OCM-defined episodes was attributable to services related to cancer care, especially antineoplastic drug therapy. Inability to control nononcology spending may present challenges for practices participating in the OCM, however.

scholarly journals MP86-04 INITIAL EXPERIENCE OF A UROLOGY PRACTICE PARTICIPATING IN AN EPISODE-BASED PAYMENT MODEL FOR CANCER CARE, THE ONCOLOGY CARE MODEL (OCM)

2018 ◽  
Vol 199 (4S) ◽  
Author(s):  
Jeremy Shelton ◽  
Richard David ◽  
Shirley Lee ◽  
Melanie Reed ◽  
Kambiz Dardashti ◽  
...  
Keyword(s):  
Cancer Care ◽  
Initial Experience ◽  
Care Model ◽  
Payment Model ◽  
Oncology Care

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community

2017 ◽  
pp. 460-466 ◽  
Author(s):  
Ron Kline ◽  
Kerin Adelson ◽  
Jeffrey J. Kirshner ◽  
Larissa M. Strawbridge ◽  
Marsha Devita ◽  
...  
Keyword(s):  
New York ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Center ◽  
Fee For Service ◽  
Community Practice ◽  
Care Model ◽  
Practice Redesign ◽  
Oncology Care

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.

scholarly journals Exploring the Experiences of Patients in the Oncology Care Model

2020 ◽  
Vol 16 (12) ◽  
pp. e1433-e1440
Author(s):  
Elizabeth F. Franklin ◽  
Helen M. Nichols ◽  
Linda Bohannon
Keyword(s):  
Adverse Effects ◽  
Cancer Care ◽  
Survey Methodology ◽  
Cross Sectional Study ◽  
Care Team ◽  
Care Model ◽  
Social Emotional ◽  
Cross Sectional ◽  
Cancer Support ◽  
Oncology Care

PURPOSE: The Oncology Care Model (OCM) was developed to improve care while also supporting patient-centered practices. This model could significantly affect experiences of patients with cancer; however, previous studies have not explored patient perspectives. PATIENTS AND METHODS: This cross-sectional study used focus group and survey methodology to explore patient experiences in the OCM. The sample included 213 patients (OCM patients, n = 130 recruited within OCM practices; non-OCM patients, n = 83 recruited via e-mail from the Cancer Support Community Cancer Experience Registry). RESULTS: Findings suggest that patients in OCM practices were more likely to report that their cancer care team asked about social/emotional distress or concerns and more likely to have social/emotional resources offered. OCM patients were also more likely to have discussed advance directives with providers. They were also more likely to be satisfied with provider explanations of treatment benefits as well as treatment risks and adverse effects. Lastly, OCM patients were significantly more satisfied with discussion of treatment costs and provided higher ratings of preparation by their cancer care team for management of adverse effects. CONCLUSION: Patients in this study reported experiences consistent with many of the key goals of the OCM. This is promising and may indicate the need to expand the model. However, because of the potential selection bias of our sampling method, more research is needed.

Funding Cancer Quality Improvement: Payer's Perspective

2015 ◽  
Vol 11 (3) ◽  
pp. 180-181 ◽  
Author(s):  
Heidi Schumacher
Keyword(s):  
Quality Improvement ◽  
Care Coordination ◽  
Cancer Care ◽  
Care Model ◽  
Payment Model ◽  
Oncology Care

The CMS Innovation Center has developed an oncology payment model, the Oncology Care Model, which aims to test the effect of care coordination on cancer care.

The Oncology Care Model and Other Value-Based Payment Models in Cancer Care

JAMA Oncology ◽  
2019 ◽  
Vol 5 (3) ◽  
pp. 298 ◽  
Author(s):  
Emeline M. Aviki ◽  
Stephen M. Schleicher ◽  
Samyukta Mullangi
Keyword(s):  
Cancer Care ◽  
Care Model ◽  
Oncology Care ◽  
Payment Models

scholarly journals Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool

2018 ◽  
pp. 1-9
Author(s):  
Chika R. Nwachukwu ◽  
Omobola Mudasiru ◽  
Lynn Million ◽  
Shruti Sheth ◽  
Hope Qamoos ◽  
...  
Keyword(s):  
Palliative Care ◽  
Needs Assessment ◽  
Cancer Care ◽  
Assessment Tool ◽  
Hospital Staff ◽  
Teaching Hospitals ◽  
High Quality ◽  
Middle Income ◽  
Quality Cancer Care ◽  
Oncology Care

Purpose Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

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