The Oncology Care Model: A Critique.

Area of Science:

• Health economics
• Oncology care delivery
• Healthcare policy

Background:

• National healthcare expenditures are rising, particularly for cancer care, driven by hospital and pharmaceutical costs.
• The current fee-for-service (FFS) system may contribute to escalating costs.
• Previous pilots, like the Center for Medicare & Medicaid Innovation (CMMI)-sponsored COME HOME model, showed potential for savings through integrated care.

Purpose of the Study:

• To introduce and critically discuss the proposed Oncology Care Model (OCM).
• To highlight the differences between OCM and the prior COME HOME model.
• To prepare oncologists for the OCM's implementation and discuss its potential impact on cost and quality.

Main Methods:

• The Oncology Care Model (OCM) pilot program is described.
• Key features of OCM, including its payment structure and performance incentives, are outlined.
• The discussion of OCM involves practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.

Main Results:

• The COME HOME model demonstrated savings by reducing hospital admissions and emergency department referrals.
• OCM provides per-patient payments and allows practices to share in savings achieved through cost reduction.
• Quality metrics and inclusion of all chemotherapy and supportive care drugs are integral to OCM.

Conclusions:

• OCM represents a significant shift from previous models, aiming to balance cost reduction with quality improvement in cancer care.
• The model's success hinges on practices' ability to manage overall care costs and meet quality standards.
• Further discussion and evaluation at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting are planned.