Oncology Care Model

Understanding the Oncology Care Model and How It Benefits You

There have been many different medical payment models designed to provide patients with optimal care. One of those models is the Oncology Care Model, designed to improve the effectiveness and efficiency of primary and special care treatments. The overall goal of the model is to improve care coordination, appropriateness, and access for beneficiaries undergoing chemotherapy. Participating practices receive a monthly care coordination fee once a patient starts chemo, which can support the new infrastructure and resources needed to develop a comprehensive delivery of care. 

South Coast Post Acute is one of the premier post-acute facilities in Southern California. When you become a patient of ours, you’ll quickly realize we’re not an ordinary medical provider. We have a strong dedication towards our patients and a high standard of care to ensure you avoid rehospitalization. 

What You Can Expect from the Oncology Care Model

The overall goal of the model aims to improve health outcomes for patients, mainly those battling cancer. This involves what is often called the “triple aim”: better care, smarter spending, and healthier people. The model emphasizes treatment for cancer patients because they comprise a medically complex and high-cost, high-risk population. The Center for Medicare and Medicaid Innovation outlines several of the key opportunities the oncology care model benefit has, such as:

  • Improved shared decision-making
  • Improved patient-centered communication
  • Reductions in complications of cancer and cancer treatments
  • Reduced emergency department visits
  • Improved quality of care and reporting

One of the key components of this care model involves developing a care plan that covers 13 components of the Institute of Medicine’s care management plan. It is expected that physician practices selected for participation in the model will transform care delivery for cancer patients undergoing chemotherapy. Resulting in improved quality of care at a decreased cost to the patient. 

How Does the Oncology Care Model Work?

It’s important to understand that the model operates on top of Medicare’s current fee-for-service system for cancer care. As mentioned, the model is designed to provide support for cancer patients. This involves creating incentives to improve the quality of care in two ways:

  • Monthly per-beneficiary-per-month payment for the duration of each chemotherapy episode
  • A performance-based payment for associated episodes of cancer care. Episodes are defined as 6 month periods of time and are renewable, and Medicare pays the oncology practice a monthly PBPM care coordination fee

Practices that follow an Oncology Care Model will receive $160 a month for each patient for the duration of their chemotherapy episode of care. This is intended to assist providers in managing and coordinating care for these patients. Not to mention provide an incentive for practices to improve the quality of care and reduce their costs. 

The performance-based fee payment will also further determine the success of a practice’s performance by including the achievement of quality metrics established by the National Quality Forum. Practices may be required to provide 24/7 patient services, proof of EHR certification, and patient navigation services. 

How Do Medical Facilities Participate in the Oncology Care Model? 

Physician practices that furnish chemotherapy treatment can participate in the model.  Additionally, they must

  • Provide the core functions of patient navigation
  • Document a care plan that contains the 13 components in the Institute of Medicine Care Management Plan
  • Provide 24 hours a day, 7 days a week patient access to an appropriate clinician
  • Treat patients with therapies consistent with nationally recognized clinical guidelines:
    • Use data to drive continuous quality improvement
    • Use an ONC-certified electronic health record and attest to Stage 2 of meaningful use by the end of the third model performance year.

South Coast Post Acute Has a High Standard for Care

A successful post-acute facility begins with a high level of care. At South Coast Post Acute we are committed to providing excellent services for our clients to ensure an effective recovery with a low chance of rehospitalization. We are passionately dedicated to providing the quality of service and care you come to expect from Southern California’s leading post-acute care provider. Through our innovative care and dedicated, experienced staff, we strive to provide the best patient care with a focus on reducing your length of stay when possible and preventing 30-day rehospitalizations. Contact us today to learn how we can help you on your journey back to full health.

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