Six years after its launch, CMS’ Oncology Care Model ended on June 30, 2022. Oncology practices that participated and stayed through the entirety of the program had clinical buy-in for the delivery of value-based care for cancer patients. However, despite CMS’ desire for a replacement model to continue OCM’s practice transformation, its Enhancing Oncology Model didn’t attract critical mass. At this point, you may be asking yourself, “What happened to all the practices that participated in OCM? Why didn’t they choose to continue?” In this blog, DataGen will answer those questions with three observations about EOM. Observation #1: Failure to meaningfully incorporate clinical adjustments CMS failed to incorporate clinical adjustments into EOM’s target price methodology in a meaningful way, beyond what was demonstrated in the final performance periods of OCM . Instead of factoring clinical data elements into the underlying cancer-specific regression models, EOM continues to incorporate a ...

CMS’ new Enhancing Oncology Model seeks to improve cancer care coordination, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. Launched July 1, EOM replaces the Oncology Care Model as CMS seeks to build on lessons learned and challenges of cancer care cost management. In this blog, we explore five best practices your oncology practice can use to kick-start EOM. How to operationalize your Enhancing Oncology Model 1. Lay the foundation with core value-based care principles While CMS models change, many value-based care elements are evergreen and can benefit from practices that: identify physician champions; inform and align practice leadership; define success markers to track progress; identify core team member roles and goals; and establish quality measure reporting. The latter may require EOM practices to add metrics to their electronic health records, such as depression screening and pain management. While this example is model-...

After a six-year run, the Oncology Care Model is due to sunset in June. Designed to provide better quality, highly coordinated oncology care, OCM offered oncologists the opportunity to improve person-centered care. It also gave participating practices access to new data across the care continuum to support practice transformation. Practices that participated in OCM were required to commit to providing enhanced services to their Medicare patients. These enhanced services, which were well received by cancer patients, became part of the practices’ transformation plans. Practices focused on: better symptom management to reduce emergency department utilization; depression and pain screenings to support psychosocial needs; navigation for high-risk patients; advanced care planning; and end-of-life care. The challenges of implementing the Oncology Care Model Despite the care delivery improvements made under OCM, participating practices faced several challenges that...

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.

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 .