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The Fallacy of Estimating OCM Target Prices

By: Darcie Hurteau and Alyssa Dahl

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Estimating episodic target prices for each patient in the Oncology Care Model (OCM) can be challenging and time consuming. Applying that time to quality-focused care management tactics, based on observed utilization and patient outcomes, may wind up being more valuable, and help to reduce unnecessary spending.

The Oncology Care Model (OCM) is a 5-year alternative payment model (APM) for oncology practices and independent practitioners that began on July 1, 2016. Participants, whose episode cycles run for 6 months, received their fourth performance data feed from CMS in December 2017.

OCM is very different from traditional bundled payment models like Bundled Payments for Care Improvement and the Comprehensive Care for Joint Replacement, because CMS views oncology care as life-encompassing. Because providers are managing not just the cancer, but a complex set of factors affecting the patient, each patient essentially has their own unique target. This is based on their personal risk factors and specific events that occurred within the episode time period.

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