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CMS aims to change how providers, payers pay for cancer treatment

New initiative to focus on specialty payment and delivery models

The Centers for Medicare & Medicaid Services (CMS) plans to implement new specialty payment and delivery models designed to improve oncology care at a lower cost for Medicare beneficiaries, the agency recently announced.

The Oncology Care Model (OCM) will have physician practices enstate payment methods that include financial and performance accountability for care administered to chemotherapy patients. CMS hopes for payer participation as well.

Through financial incentives, the goal of OCM is to improve care coordination for those undergoing chemotherapy. The payment method, known as an episode-based payment, "financially incentivizes high-quality, coordinated care," CMS noted.

The announcement follows in the footsteps of the Department of Health and Human Services' recent announcement to speed up plans for value-based payments by reforming how it pays providers for treating Medicare patients in the coming years.

CMS hopes to align financial incentives across multiple payers to coordinate better care across a broader population. Payers then, in turn, would experience an increase in financial benefits and savings, as well as better outcomes for their members. Should payers participate in the OCM, they will be able to design their own payment incentives.

The payment method comes in two phases: A monthly per-beneficiary-per-month payment for the duration of the episode as well as the potential for a performance-based payment for episodes of chemotherapy care, according to CMS.

Around the country, some payers already are transforming how they pay for cancer patients. UnitedHealth, for instance, announced it will pay MD Anderson Cancer Center in Houston a flat fee to provide head and neck cancer care. The new bundled payment program is part of UnitedHealth's effort to increase its value-based reimbursements, which it said has already tripled to $36 billion since 2011.

Payers interested in the OCM have until March 19 to submit a non-binding letter of intent to CMS. Practices have until April 23. Those who submit "timely, complete" letters of intent will be eligible to submit applications, which will be due June 18, CMS said.

For more:
- here's the CMS announcement

Related Articles:
UnitedHealth to bundle payment for MD Anderson Cancer Care
Feds speed plans for value-based payments
UnitedHealth's Lee Newcomer: Effective bundled payments require physician leaders, collaboration