The Centers for Medicare & Medicaid Services (CMS) has selected Montefiore Einstein Center for Cancer Care as one of nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality, more coordinated cancer care.

“When a patient gets a cancer diagnosis, they are not suddenly cured of other health issues like diabetes or hypertension,” said Steven K. Libutti, M.D., F.A.C.S., director, Montefiore Einstein Center for Cancer Care, professor and vice chairman of the Department of Surgery at Montefiore and Albert Einstein College of Medicine. “That is why close coordination from different disciplines is so important. By participating in CMS’ new Oncology Care Model, we are building on Montefiore’s rich history of care coordination and aligning financial incentives to provide the highest quality of care that addresses each person’s unique care needs.”

Cancer is one of the most prevalent and devastating diseases in the United States: more than 1.6 million new cases of cancer will be diagnosed in 2016. According to the National Institutes of Health, medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion – an increase of 27 percent in a decade. A significant proportion of people diagnosed are over 65 years old and are Medicare beneficiaries.

“The Oncology Care Model encourages greater collaboration, information sharing, and care coordination, so that patients get the care they need, when they need it,” said Health and Human Services Secretary Sylvia M. Burwell. “This patient-centered care model fits within the Administration’s dual missions for delivery system reform and the White House Cancer Moonshot Task Force – to improve patient access and improve quality of health care while spending dollars more wisely.”

The Oncology Care Model is one of the first CMS physician-led specialty care models and builds on lessons learned from other innovative programs and private-sector models. It encourages practices to improve care and lower costs through episode- and performance-based payments that reward high-quality patient care. More than 3,200 oncologists are participating in the model. It will cover approximately 155,000 Medicare beneficiaries nationwide.

As part of this model, physician practices may receive performance-based payments surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Practices participating in the five-year Oncology Care Model will provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on person-centered care. These services may include:

• Coordinating appointments with providers within and outside the oncology practice to ensure timely delivery of diagnostic and treatment services;
• Providing 24/7 access to care when needed;
• Arranging for diagnostic scans and follow up with other members of the medical team such as surgeons, radiation oncologists, and other specialists
• Making sure that data from scans, blood test results, and other tests are received in advance of appointments so that patients do not need to schedule additional visits; and
• Providing access to additional patient resources such as emotional support groups, pain management services, and clinical trials.

“CMS is thrilled with how many physician groups chose to be a part of the Oncology Care Model,” said Patrick Conway, M.D., CMS principal deputy administrator and chief medical officer. “We have nearly doubled the number of participants that we anticipated. It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care. As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”

The Oncology Care Model begins this month and runs through June 30, 2021.

“The number of hospital appointments, combined with the side effects associated with chemotherapy can be grueling and daunting for the patients impacted by cancer and their families,” said Stuart H. Packer, M.D., medical director, Department of Medical Oncology, Montefiore Einstein Center for Cancer Care and assistant professor, Department of Medicine (Oncology), Einstein. “Through funding from the new Oncology Care Model, we are thrilled to be able to provide an enhanced level of access to clinicians and support to help each patient successfully navigate through their cancer journey.”

As part of the Administration’s “better care, smarter spending, healthier people” approach to improving health delivery, the Oncology Care Model is one of many innovative payment and care delivery models developed by the CMS Innovation Center and advanced by the Affordable Care Act. The Innovation Center is committed to transforming the Medicare, Medicaid and Children’s Health Insurance Program (CHIP) programs and is expected to help deliver better care for individuals, better health for populations, and lower growth in expenditures for Medicare, Medicaid and CHIP beneficiaries.