The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chroni...

Alternative payment programs are critical to payment and care delivery transformation. CMS is introducing new alternative payment models that provide opportunities to deliver better value of care and support healthcare innovation in the years to come. Rising healthcare trends should be taken into consideration when evaluating new APMs. Yet, keeping ahead of which programs offer you the greatest opportunity can be a major challenge. DataGen put together Navigating Alternative Payment Models: A User's Guide , offering insights on the participation categories—and detail on programs within each category—this resource can help you determine the best course for your organization’s future. Download our user's guide to learn about new APMs, implications for providers and data-driven strategies for successful pro gram execution.

It’s been a year: a year since the first lockdowns and a year since the landscape of healthcare in the U.S. changed forever. While we’re still evaluating the impacts of the pandemic on healthcare policy, we now have seen enough data to assess the effect of the past year on alternative payments models and how participants are reacting. It’s been reassuring to see the strength of APMs has broadly held steady, as has the resolve of the participants in those programs, despite the impact of the COVID-19 pandemic. Here’s what we’ve learned this year, along with what (we think) those lessons can teach us about the future. COVID-19 has not stopped the progress of APMs — but it is delaying it. COVID-19 has extended the period of some programs, like the Comprehensive Care for Joint Replacement and Oncology Care Model, and delayed the start of others, like Kidney Care First and the Radiation Oncology Model. This is, in part, a function of an overwhelmed system. As policymakers and healthcare org...

The COVID-19 pandemic has impacted every aspect of our healthcare system. That’s true for participants in the Oncology Care Model and Bundled Payments for Care Improvement Advanced programs. Organizations in these programs had to make important decisions regarding the overlap of their program performance periods with the COVID-19 public health emergency. Several trends have begun to emerge from these choices. Here’s what DataGen’s analysts have seen from the data: BPCIA For performance periods that overlapped with the PHE, BPCIA participants had to decide if they would remove all upside and downside risk, or just remove COVID-19 patients from their reconciliation. From our analysis, it appears that decisions were balanced between these two options. We are not aware of any episode initiators who chose to continue their reconciliations as usual with no exclusions at all. Here’s what we believe drove those decisions: Opting out of the performance period reconciliation entirely by removing...

The challenges and benefits of bundled payments and risk-based arrangements is one of the biggest issues facing the healthcare field. Kelly Price, DataGen’s Vice President and Chief of Healthcare Data Analytics, and Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners sat down to help shed some light on ways to succeed with bundled payments and risk-based payment models. Read more about this conversation in our new installment, “The Future of Payment Reform: How can providers, patients, and payers benefit—and who bears the burden? ” 

As we look ahead to 2017—a year that’s sure to bring changes to the way healthcare is delivered under the new Trump Administration—Kelly Price, DataGen’s Vice President and Chief of Healthcare Data Analytics, sat down with Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners, to provide expert perspective on the current and future states of payment reform. Download 

Announced by the CMS in January 2015, OCM is one of the most recent programs in a litany of new experiments.   Simplifying and organizing the complex data and policy component of this program requires specialized expertise in healthcare analytics. Read about DataGen's recent work related to the OCM in Achieving Data-Driven Success Under the OCM , which identifies four critical areas data analytics will need to address for any bundled payment model. Download the article .