The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models is the Oncology Care Model, which aims to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. Under the Oncology Care Model (OCM), physician practices have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. The Centers for Medicare and Medicaid Services (CMS) is also partnering with commercial payers in the model. The practices participating in OCM have committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and national treatment guidelines for care.
If you are looking for beneficiary-focused information about OCM, please visit the OCM beneficiary-focused resource on Medicare.gov.
Select anywhere on the map below to view the interactive version
As of July 2, 2021 there are 126 practices and 5 commercial payers participating in the Oncology Care Model.
To view an interactive map of this Model, visit the Where Innovation is Happening page. The 5 participating payers are:
- Aetna
- BlueCross BlueShield of South Carolina
- Cigna Life & Health Insurance Company
- Priority Health
- The University of Arizona Health Plan
Background
Cancer diagnoses comprise some of the most common and devastating diseases in the United States: more than 1.6 million people are diagnosed with cancer each year in this country. Through OCM, the CMS Innovation Center has the opportunity to achieve three goals in the care of this medically complex population: better care, smarter spending, and healthier people.
Model Details
The goal of OCM is to utilize appropriately aligned financial incentives to enable improved care coordination, appropriateness of care, and access to care for beneficiaries undergoing chemotherapy. OCM encourages participating practices to improve care and lower costs through an episode-based payment model that financially incentivizes high-quality, coordinated care. The CMS Innovation Center expects that these improvements will result in better care, smarter spending, and healthier people. Practitioners in OCM are expected to rely on the most current medical evidence and shared decision-making with beneficiaries to inform their recommendation about whether a beneficiary should receive chemotherapy treatment. OCM provides an incentive to participating physician practices to comprehensively and appropriately address the complex care needs of the beneficiary population receiving chemotherapy treatment, and heighten the focus on furnishing services that specifically improve the patient experience or health outcomes.
Commercial payers are participating in OCM in alignment with Medicare to create broader incentives for care transformation at the physician practice level. Aligned financial incentives that result from engaging multiple payers leverage the opportunity to transform care for oncology patients across a broader population. Other payers benefit from savings, better outcomes for their beneficiaries, and greater information around care quality. Participating payers have the flexibility to design their own payment incentives to support their beneficiaries, while aligning with the Innovation Center’s goals for care improvement and efficiency.
OCM incorporates a two-part payment system for participating practices, creating incentives to improve the quality of care and furnish enhanced services for beneficiaries who undergo chemotherapy treatment for a cancer diagnosis. The two forms of payment include a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the duration of the episode and the potential for a performance-based payment for episodes of chemotherapy care. The $160 MEOS payment assists participating practices in effectively managing and coordinating care for oncology patients during episodes of care, while the potential for performance-based payment incentivizes practices to lower the total cost of care and improve care for beneficiaries during treatment episodes.
Electronic Health Records (EHR) Workgroup
The Oncology Care Model is working with EHR vendors in a workgroup to review data needs for OCM implementation and strategies to support practices in reporting data to the OCM Data Registry. If you are an EHR vendor interested in participating in this group, please contact OCMSupport@cms.hhs.gov. Detailed technical documents related to OCM's quality measures and clinical data reporting requirements are also available.
- Oncology Care Model Pledge Form (PDF) - pledge form for interested vendors to complete and submit to OCMSupport@cms.hhs.gov. Please include “OCM Vendor Pledge – [Vendor Name]” in the subject line of the email.
- Oncology Care Model Vendor List (XLS) - vendors who have completed the OCM Vendor Pledge
Evaluations
Latest Evaluation Report
- Oncology Care Model - Payment Impacts Evaluation Report: Periods 1-6 (PDF)
- Two Pager: At-A-Glance Report (PDF)
Prior Evaluation Reports
- Two Pager: At-A-Glance Report (PDF)
- Two Pager: At-A-Glance Report (PDF)
- White Paper - Episode Payment Models Evaluation Synthesis (PDF)
- Second Annual Report Two Pager: At-A-Glance Report (PDF)
- First Annual Report
Additional Information
- Oncology Care Model Fact Sheet
- Oncology Care Model Press Release (06/29/2016)
- Oncology Care Model Press Release (02/12/2015)
- Video: Oncology Care Model Experiences - Northwest Medical Specialties
- Video: Oncology Care Model Experiences - The Center for Cancer and Blood Disorders
- Oncology Care Model beneficiary-focused resource on Medicare.gov
Model Materials
- Oncology Care Model Overview Slides (PDF)
- Oncology Care Model General Program Documents (ZIP)
- Oncology Care Model Data Registry (ZIP)
- Oncology Care Model Key Drivers and Change Package (PDF)
- Oncology Care Model Beneficiary Notification Letter Template (PDF)
- Oncology Care Model Beneficiary Notification Letter Template - Spanish (PDF)
- Oncology Care Model Connect
Methodology
- Oncology Care Model Performance Periods 1 and 2 Payment Methodology (PDF)
- Oncology Care Model Performance Period 3 and Forward Payment Methodology (PDF)
- Oncology Care Model Novel Therapy Drug List Effective May 2022 (XLS)
- Oncology Care Models Initiating Therapies List Effective July 2021 (XLS)
Data Reporting
Staging and Clinical Data
- Oncology Care Model Staging and Clinical Data (ZIP)
- Oncology Care Model Performance Period 4 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 5 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 6 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 7 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 8 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 9 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 10 Staging and Clinical Data Reporting (ZIP)
- Oncology Care Model Performance Period 11 Staging and Clinical Data Reporting (ZIP)
Quality Measures
- Oncology Care Model Quality Measures (ZIP)
- Oncology Care Model January - June 2019 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model July - December 2019 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model January - June 2020 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model July - December 2020 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model January – June 2021 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model July – December 2021 Measurement Period Aggregate Measure Result Reporting (ZIP)
- Oncology Care Model January – June 2022 Measurement Period Aggregate Measure Result Reporting (ZIP)