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.
What to Expect from the Oncology Care Model
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.
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
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