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Data Challenges Under the Oncology Care Model

By: Darcie Hurteau and Alyssa Dahl

DataGen’s article was recently featured on

The first 12 months of the Oncology Care Model (OCM) have been a significant learning experience, especially with the data CMS is providing to participants. When the practices we work with received their first performance period data back in spring 2017, there were some surprises. This performance period data comes in the form of claims data, which is part of a feedback report issued by CMS. However, participants found that the data did not resemble what they were used to working with from the historic baseline period data.

Here are 6 factors that make the OCM performance period data challenging to navigate and use:

1. The structure of the claims data is problematic. CMS is not providing episodic performance period data to practices until reconciliation.  While financial performance will be based on episodes, the claims data currently being provided for the performance period is not structured for episodic monitoring. The claims data looks at each quarter in isolation as opposed to 6-month episodes of care. Additionally, the data includes every patient that had a visit with a particular practice, though not every patient will necessarily be attributed to or receive chemotherapy at the practice.

The utility of the current claims data can be challenging for practices that requested their baseline data and now have the feedback report claims data as their only information on the performance period. At times, practices have had difficulty reconciling the differences between what’s displayed in this set of claims data, versus what the historic episodic data showed, versus the data in their internal systems.

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