CMS Announces OCM Participants: Three Notable Facts

On June 29, HHS announced its selection of oncology physician group practices and health insurance companies to participate in the Oncology Care model (OCM), a five-year bundled payment initiative that starts July 1 and will cover more than 3,200 oncologists and 155,000 Medicare beneficiaries. The program provides a $160 care management payment per beneficiary per month, in addition to performance-based payments.

Below are a few notable aspects of the OCM participant selection announcement.

  1. Twice the Anticipated Participation. The CMS announcement notes that 196 physician groups are selected to participate in OCM, almost double the amount the agency hoped would engage in the model when they released the CMS Request for Application (RFA) on February, 2015 . A map indicating where the participating practices are located is below. A list of the selected OCM providers and payers can be found here.

Graphic 1: Map of Physician Groups Participating in OCM

CMS map

  1. Piggyback for 17 Payers: While CMS did not originally state a goal for payer participation, the list of 17 payers participating in OCM – including Aetna, four Blues, Cigna, and Highmark – is impressive. Recall that practices were given 30 bonus points on their OCM application if they were able to enlist a payer to implement an OCM-like program for their commercial or Medicare Advantage patients. We do not know which of the 196 providers are paired with one or more of the payers, but we do know that 40 payers submitted applications and 17 were selected. These private insurances may view participation with OCM as an opportunity to advance their own similar objectives of improving chemotherapy outcomes while lowering costs.
  1. Large Interest. The interest of oncology physician groups in OCM was high, 444 practices signed a Letter of Intent (LOI) by May 7, 2016, 196 were selected on June 29. Oncology practices see bundles as a future direction for Medicare payments and are testing the bundled payment waters via OCM.  As Patrick Conway, MD, CMS Chief Medical Officer and Principal Deputy Administrator noted, “It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care.”

Cancer is a devastating disease. According to the announcement, in 2016 1.6 million new cases of cancer will be diagnosed and the disease will kill 600,000 Americans. With OCM, CMS is helping lead the way to value-based cancer payments and incentive alignments to create better outcomes in chemotherapy, while reducing costs. As stated by Secretary Sylvia Burwell, “The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need. This patient-centered care model furthers the goal of the Vice President’s Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely.”