Medicare is looking for commercial insurance partners to join a multi-payer, physician-led effort aimed at "transforming" oncology and helping financing become more sustainable.
The Department of Health and Human Services is launching the Oncology Care Model, a new multi-payer payment and delivery program, and is calling on practitioners and insurers alike to join.
The goal of the program is to bring Medicare beneficiaries and other patients being treated for cancer "coordinated, person-centered care" with reimbursement "aimed at rewarding value of care, rather than volume." One goal of the program, for instance, is for cancer patients to have 24-hour access to a practitioner during the course of their treatment.
"Based on feedback from the medical, consumer and business communities, we are launching this new model of care to support clinicians' work with their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services. "We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide. Improving the way we pay providers and deliver care to patients will result in healthier people."
Some 1.6 million Americans are diagnosed with cancer each year, a majority of them over the age of 65. The disease costs the country an estimated $263 billion in healthcare spending and lost productivity, and spending is only bound to rise as people live longer and new drugs come out of the pipeline, some costing on the order of $100,000 per-person annually.
The Oncology Care Model, a project of the CMS Innovation Center, "will invest in physician-led practices, allowing the practices to innovate and deliver higher-quality care to their patients," Conway said. CMS is also seeking the participation of other payers, "to leverage the opportunity to transform care for oncology patients across a broader population."
The model will use episode- and performance-based payments. Participating practices will also receive monthly care management payments for each Medicare fee-for-service beneficiary -- a big part of which is the expectation of "sharing more broadly to providers, consumers, and others to support better decisions."
Physician group practices and solo practitioners that provide chemotherapy and serve Medicare beneficiaries can apply to participate, along with payers, including commercial insurers, Medicare Advantage plans, state programs and Medicaid managed care plans. Letters of intent are due by April 23.
"As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient's needs," said Conway. "CMS has the opportunity to achieve three goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people."