Physician groups, payers in new initiative to promote better cancer care

Thousands of oncologists working in nearly 200 physician group practices and 17 health insurance companies will participate in a government initiative aimed at providing better cancer care.

The practices and health payers will participate in a patient-centered care delivery model that supports and encourages higher quality and more coordinated cancer care, the U.S. Department of Health and Human Services said in an announcement. The initiative, called the Oncology Care Model, attracted almost twice the expected number of physician practices, HHS said. The initiative incudes more than 3,200 oncologists and will cover about 155,000 Medicare beneficiaries across the country. The five-year initiative starts July 1 and will continue through 2021.

“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” said HHS Secretary Sylvia M. Burwell., adding the model furthers the goal of Vice President Joe Biden’s 'Cancer Moonshot' to improve coordination, care and outcomes.

The multi-payer model encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care, HHS said.

As part of this model, physician practices may receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary. The initiative is based on other innovative programs and private-sector models, HHS said. The commerical payers will work with Medicare to create broader incentives to transform care for oncology patients. Payers expect the initiative will lead to better savings, patient outcomes and greater information about care quality. 

The initiative is an Advanced Alternative Payment Model under the newly proposed Quality Payment Program that HHS put in place to implement the Medicare Access and CHIP Reauthorization Act (MACRA).

The physician practices participating in the model will provide enhanced services to patients that may include benefits such as 24/7 access to care when needed; coordinated appointments within and outside the oncology practice to ensure timely delivery of diagnostic and treatment services; and access to emotional support groups, pain management and clinical trials.

- read the announcement
- learn more about participating practices and payers