HHS Selects Physician Groups for Cancer Care Initiative

The U.S. Department of Health and Human Services (HHS) has selected nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality and more coordinated cancer care. The Medicare arm of the Oncology Care Model, which began July 1, 2016, and runs through June 30, 2021, includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries.

This is one of the first Centers for Medicaid and Medicare Services (CMS) physician-led specialty care models that encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality patient care. Under the model, physician practices may receive performance-based payments for episodes of care surrounding chemotherapy administration, as well as a monthly care management payment for each beneficiary, with an emphasis on person-centered care.

Practices participating in the model will provide treatment following nationally recognized guidelines that include enhanced services such as coordinating appointments with providers within and outside the oncology practice to ensure timely delivery of diagnostic and treatment services; providing 24/7 access to care when needed; arranging for diagnostic scans and follow-up with other members of the medical team such as surgeons, radiation oncologists and other specialists that support the beneficiary through their cancer treatment; making sure data from scans, blood test results and other tests are received in advance of patient appointments so that patients don’t need to schedule additional visits; and providing access to additional patient resources such as emotional support groups, pain management services and clinical trials.

“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” said Patrick Conway, MD, MSc, principal deputy administrator and chief medical officer. “We have nearly doubled the number of participants that we anticipated. It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care. 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.”