Determining Performance-Based Payments for Oncology Care

Using appropriately aligned financial incentives to enable improved care coordination, appropriateness of care, and access to care for beneficiaries undergoing chemotherapy can improve cancer care.

The Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) is an innovative, multi-payer model focused on providing higher-quality, more coordinated oncology care. Under OCM, physician group practices have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding the administration of chemotherapy to cancer patients. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries, such as care coordination and navigation, and to using national treatment guidelines for care. OCM is a 5-year model that began on July 1, 2016 and runs through June 30, 2021.

RTI helped CMS to design, implement, and monitor the OCM for close to 200 practices and 17 payers, including CMS. Participating practices cover urban, suburban, and rural areas; these practices range in size from solo oncologists to large practices with hundreds of providers. Commercial payers will align their oncology payment models with Medicare’s model and support OCM practices in their practice transformation efforts.

RTI’s expertise was significantly used in this effort to help design a performance-based payment methodology for oncology care, and this work showcases our ability to provide insights and guidance at the forefront of clinical care in oncology. As the U.S. health system starts to shift towards value over volume, this model of care and payment will be an example of how the industry must shift its thinking and its practice.

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