March 30, 2015 – The U.S. government will be launching a new cancer care initiative under President Obama’s Affordable Care Act. The goal of the program is to improve quality of care for Medicare beneficiaries and to manage the rising costs of cancer treatments.
Each year, more than 1.6 million people are diagnosed with cancer in the United States, the majority of which are over the age of 65 and Medicare beneficiaries. The National Institute of Health has estimated that cancer costs the U.S. approximately $263.8 billion in medical costs and lost productivity every year. Proponents for the new plan hope it will lead to better care, smarter spending, and healthier people.
The initiative, proposed by the Centers for Medicare & Medicaid Services Innovation (CMS), includes new payment and delivery models for specialty health care providers as a means of improving effectiveness and efficiency of specialty care. Called the Oncology Care Model, the plan will focus on quality of care, not quantity of care, for Medicare beneficiaries struggling with cancer.
The effort will focus on physician-led practices and offer appropriately aligned financial incentives designed to promote care coordination, appropriateness of care, and access to care for Medicare beneficiaries undergoing chemotherapy.
Participating providers will be required to treat patients with therapies consistent with comprehensive, current, and nationally recognized clinical practice guidelines, such as those outlined by the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO.) They must also report all treatments and outcomes to CMS for review.
Participating practices will be rewarded through financial incentives for providing services that specifically improve the patient experience and health outcomes. Providers will enter into payment arrangements that include financial and performance accountability for episodes of care surrounding the use of chemotherapy in cancer patients.
All physician group practices and solo practitioners that provide chemotherapy and are enrolled in Medicare are encouraged to participate in the program. Other payers, including commercial insurers, state programs, and Medicaid managed care plans, may also apply. Through the combined efforts of these providers, the CMS hopes to find new ways to improve and coordinate care delivery, share cancer care information more broadly among providers and consumers, and support better decisions.
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