Oncology Care Models: Moving the Needle on Alternative Payment

While recent years have brought breakthroughs in the diagnoses and treatment of cancer, there has also been an increased interest in examining new ways of paying for these life-saving services. Alternative payment models (APM) seek to deliver high-quality care through innovative payment and service delivery models. APMs incentivize those who can effectively deliver value-based care, improve efficiency of care, and support shared decision-making.

The Oncology Care Model

The most widely known cancer care APM is the Center for Medicare & Medicaid Innovation’s  Oncology Care Model (OCM). Under the OCM, physician practices and commercial health insurers participated in payment agreements that focused on meeting specific financial and performance metrics regarding the administration of chemotherapy to patients with cancer. By the conclusion of the OCM in June 2022, the model included approximately 121 cancer programs and practices, five commercial payer partners, and more than 7,000 oncology practitioners. One of the key aspects of the OCM was to collect feedback from the oncology community. This included OCM participants, patient advocacy groups, and oncology professional associations, among others. ACCC supported the OCM by providing advocacy around APMs and collecting feedback from its members.

Introducing the Enhancing Oncology Model

With lessons learned from the OCM, the CMS Innovation Center is now collaborating on a new APM and the OCM’s successor. Referred to as the Enhancing Oncology Model (EOM), this model will examine best practices in enhancing quality of care provided to patients with cancer, as well as reducing spending under Medicare fee-for-service. The EOM builds on lessons learned from the OCM and focuses specifically on implementing a robust health equity strategy and improving the patient care experience. (Learn more about the differences between these models on ACCCBuzz.) 

Anticipated to begin on July 1, 2023, this new care model will focus on patient needs by testing how oncology practitioners deliver and care for patient needs that will result in quality health outcomes. The EOM supports President Biden’s Cancer Moonshot Initiative by seeking innovative ways to improve the care of patients with cancer and their caregivers. ACCC continues to support the work of the CMS Innovation Center with this new APM. The ACCC 39th Annual National Oncology Conference (#ACCCNOC) included a breakout session: “The Enhancing Oncology Model: Are You Ready?”

This session featured a panel discussion from Prateek Bhatia, PhD, MBA, vice president of Payer Strategy, The US Oncology Network, McKesson; Alexandra Chong, PhD, MA, acting deputy director, Division of Ambulatory Payment Models, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services; David Ortiz, administrative director of Quality & Value-Based Initiatives, Montefiore Einstein Center Cancer Care; and Shiela Plasencia, director of Practice Support, Community Oncology Alliance. In addition, ACCC hosted a virtual workshop in April, 2022. Both sessions facilitated conversation around APMs, with representatives from cancer programs and practices participating in the OCM, Accountable Care Organizations, merit-based incentive payment system, and other value-based care models. 

ACCC and its membership are particularly concerned that certain proposed APMs, while well intentioned, could have a negative impact on patients with cancer and their providers in rural, underserved, and under resourced areas of the country. ACCC will continue to provide constructive feedback to APM developers, such as the CMS Innovation Center about issues like access to innovative therapies, administrative burden, and data analytics.

Learn more about ACCC’s Alternative Payment Model Coalition by contacting Regina Gibson-Burtnick, ACCC program manager, or visiting its dedicated website.

The ACCC Alternative Payment Model Coalition is supported by Merck and Takeda Oncology.