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Achieving Data-Driven Success Under the Oncology Care Model

By: Kelly Price & Alyssa Dahl

If recent trends continue, the cost of cancer care in the United States will reach $172.8 billion in 2020, a 39% increase from 2010, according to a 2011 study from the National Cancer Institute. The government is responding with several new payment models, including the Medicare Shared Savings Program, Comprehensive Primary Care Plus, and the Oncology Care Model (OCM).

Announced by CMS in January 2015, OCM is one of the most recent programs in a litany of new experiments. Hospitals and other healthcare providers that are participating in any of these programs will find it challenging to effectively evaluate and manage their activities so as to improve the effectiveness and efficiency of care and optimize the patient experience. These providers will need to review and monitor their data to determine the possibilities for success in bundled payment programs and to measure the value of participation.

Should You Participate in the OCM?

The OCM program is a 5-year alternative payment model (APM) for oncology practices and independent practitioners. It begins on July 1 of this year and provides 3 forms of reimbursement for participants: a traditional fee-for-service payment for Medicare Part A, B, and D services; a per-beneficiary-per-month (PBPM) payment for the duration of  each 6-month episode, and the potential for a retrospective, risk-adjusted payment based on performance quality metrics and actual care cost savings.

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