CMS NEWS
FOR IMMEDIATE RELEASE
February 12,
2015
Contact: CMS Media Relations
(202) 690-6145 | press@cms.hhs.gov
New Affordable Care Act initiative to encourage
better oncology care
The U.S.
Department of Health and Human Services (HHS) today announced a new multi-payer
payment and care delivery model to support better care coordination for cancer
care as part of the Department’s ongoing efforts to improve the quality of care
patients receive and spend health care dollars more wisely, contributing to
healthier communities. The initiative will include 24-hour access to
practitioners for beneficiaries undergoing treatment and an emphasis on
coordinated, person-centered care, aimed at rewarding value of care, rather
than volume.
Cancer is one of
the most common and devastating diseases in the United States: more than 1.6
million people are diagnosed with cancer each year in this country. According
to the National Institutes of Health, cancer cost the
United States an estimated $263.8 billion in medical costs and lost
productivity in 2010. A majority of those diagnosed are over 65 years old and
Medicare beneficiaries.
“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,” added
Dr. Conway. “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.”
As part of the
Department’s “better
care, smarter spending, healthier people” approach to improving health
delivery, the Oncology Care Model is one of many innovative payment and care
delivery models developed by the Centers for Medicare & Medicaid Services
(CMS) Innovation
Center and advanced by the Affordable
Care Act. The model was created in response to feedback from the oncology
community, patient advocates, and the private sector that a new way of paying
for and delivering oncology care is needed. This model will invest in
physician-led practices, allowing the practices to innovate and deliver
higher-quality care to their patients. CMS is seeking the participation of
other payers in the model to leverage the opportunity to transform care for
oncology patients across a broader population.
The Oncology Care
Model encourages participating practices to improve care and lower costs
through episode-based, performance-based payments that financially incentivize
high-quality, coordinated care. Participating practices will also receive
monthly care management payments for each Medicare fee-for-service beneficiary
during an episode to support oncology practice transformation, including the
provision of comprehensive, coordinated patient care.
To achieve better
care, smarter spending and healthier people, HHS is focused on three key areas:
(1) linking payment to quality of care, (2) improving and innovating in care delivery,
and (3) sharing information more broadly to providers, consumers, and others to
support better decisions while maintaining privacy. Today’s news comes on the
heels of Secretary Burwell’s recent announcement
that HHS is setting measurable goals and a timeline to move Medicare toward
paying providers based on the quality, rather than the quantity of care they
give patients.
“With the Oncology
Care Model, 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,” said Dr. Conway. “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.”
The Oncology Care
Model will provide support for participating physician practices to address the
complex care needs of the beneficiary population receiving chemotherapy
treatment and will reward practices that focus on furnishing services that
specifically improve the patient experience and health outcomes.
Physician group
practices and solo practitioners that provide chemotherapy for cancer and are
currently enrolled in Medicare may apply to participate. Other payers,
including commercial insurers, Medicare Advantage plans, state programs, and
Medicaid managed care plans, are also encouraged to apply. To be considered,
interested payers must submit a letter of intent through the Oncology Care
Model inbox at OncologyCareModel@cms.hhs.gov
by 5:00 p.m., EDT on March 19, 2015. Interested practices must submit letters
of intent by 5:00 p.m., EDT on April 23, 2015. Payers and practices that submit
a timely letter of intent will be sent an authenticated web link and password
with which to submit an electronic application. Applications must be submitted
by 5:00 p.m., EDT on June 18, 2015.
For more
information on the Oncology Care Model, please visit: http://innovation.cms.gov/initiatives/Oncology-Care/.
The Innovation Center was created
by the Affordable Care Act to test innovative payment and service delivery
models to reduce CMS program expenditures while preserving or enhancing the
quality of care for CMS beneficiaries. The Innovation Center is committed to
transforming the Medicare, Medicaid and Children’s Health Insurance Program
(CHIP) programs and is expected to help deliver better care for individuals,
better health for populations, and lower growth in expenditures for Medicare,
Medicaid and CHIP beneficiaries.
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Helpful Weblinks:
CMS Press Release: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-02-12.html
CMS Fact Sheet: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12.html
Oncology Care Model (OCM)
(CMS-5514-N) PDF Copy at Federal Register: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-03060.pdf
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