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Bundled Payment Model Attracts More Oncologists than Expected

The CMS bundled payment model revolving around oncology is bringing in twice as many provider organizations as initially anticipated.

Oncology Care Model

Source: Thinkstock

By Vera Gruessner

- The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations participating than initially expected, according to a company press release from Archway Health.

Archway Health specializes in helping providers implement and succeed in operating bundled payment models. The company announced yesterday that 10 different oncology providers have requested their assistance for participating in the Oncology Care Model since the CMS bundled payment model began in July 2016.

Additionally, shortly prior to the release of the finalized Oncology Care Model, an extra eight providers requested Archway Health for assistance in meeting the requirements of the bundled payment model.

“The growth and participation among cancer facilities in OCM is a positive sign in the transition to value-based payment and specifically, bundled payments and the future of healthcare,” said Dave Terry, Co-Founder and CEO of Archway Health. “The organizations participating in the OCM model are demonstrating a commitment to innovating and improving the quality of care and lessening the financial burden for their patients. They are leading the way in delivering high-value healthcare.”

The providers that are seeking consulting services from Archway Health to succeed in this particular bundled payment program include Cancer & Hematology Centers of Western Michigan, Lancaster General Cancer Institute, Cancer Specialists of North Florida, and Oklahoma Cancer Specialists and Research Institute.

READ MORE: 17 Health Payers Participating in CMS Oncology Care Model

The Oncology Care Model currently has more than 200 providers participating in the bundled payment contracts. Additionally, 17 health insurance companies are also participating in the CMS bundled payment model.

The Oncology Care Model involves holding oncologists and clinics accountable for healthcare costs and patient outcomes during an episode of care related to chemotherapy treatment given to cancer patients.

Archway Health helps providers with the implementation and management of the Oncology Care Model including adopting the right patient tracking tools, opportunity identification, compliance with bundled payment requirements, and physician practice transformation.

“Our institution has always sought new ways to improve patient care, while reducing costs,” said Dennis Zoet, Senior Director of Business Development and Operations, Cancer & Hematology Centers of Western Michigan. “The OCM model allows us to do just that within our population of patients battling cancer. Given the breadth and depth of their experience within bundled payments, Archway Health is an ideal partner to help us navigate and succeed within this new landscape.”

Along with the Oncology Care Model, CMS has invested in bundled payment models for orthopedic and cardiac care. At the end of 2016, CMS released its finalized bundled payment programs for cardiac and orthopedic care. An initial report was also published last September showing that the Bundled Payments for Care Improvement (BPCI) program led to an average of $864 per episode of orthopedic surgery and care in savings for model 2 hospitals.

READ MORE: Bundled Payment Models Need to Align Payer, Provider Incentives

Last month, Dave Terry spoke with HealthPayerIntelligence.com to discuss some of the difficulties of rolling out these bundled payment programs. In general, the first steps for creating the major reimbursement transformation through the BPCI program was a complex endeavour for CMS.

“CMMI [Center for Medicare & Medicaid Innovation] programs are seeing cost savings. A study was reported in 2014 showing they’re seeing savings for many bundles. CMS is pushing forward more bundled payment models because of these cost savings,” Terry said. ““For CMS, the biggest challenge was starting the BPCI program. The first proposals came out in 2011 but it was finalized only in late 2013. The design, reconciliation, and sharing data were some of the challenges CMS encountered that are now reconciled. CMS spent time making sure providers have scale.”

Terry explained that private payers adopting bundled payment models will need to learn to scale as well as decide on definitions and which episodes of care to participate in. Through the Bundled Payments for Care Improvement program, CMS and providers were able to decrease hospital readmission rates and lengths of stay.

“As of August 2016, CMS bundled payment models have shown positive outcomes with a reduction in hospital readmissions,” Terry added. “Patients are returning home faster from nursing homes. Patient outcomes in mobility have been positive. Most of all, readmissions dropped.”

The Oncology Care Model along with other CMS bundled payment programs are becoming more popular as more healthcare providers continue to transition to value-based care reimbursement. Private payers that haven’t yet should look to invest in bundled payment models to improve the quality of care and reduce spending.

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