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UPMC CancerCenter oncologists and the UPMC Health Plan have been selected as one of nearly 200 physician group practices and 17 health insurance companies to participate in an innovative federal program designed to enhance quality and coordination of care for cancer patients, while lowering costs.
The five-year Oncology Care Model (OCM) pilot payment project, overseen by the Centers for Medicare and Medicaid Services (CMS), aims to align physician incentives with improvements in the effectiveness and efficiency of cancer care delivery. As part of CMS’s broader move to pay physicians for “value” instead of volume, the program aims to reduce unnecessary hospitalizations and emergency room visits by helping patients with improved coordination of and access to key services.
The participating UPMC practice, Oncology Hematology Associates (OHA), is one of the largest integrated community networks of cancer care specialists in the country, providing the latest advances in cancer prevention, detection, diagnosis and treatment. OHA has more than 19 sites throughout western Pennsylvania and has over 168,000 patient visits a year.
“As one of the largest integrated health care provider-payer systems in the country, UPMC has been a leader in developing new models of accountable, patient-focused care,” said Peter Ellis, M.D., deputy director for clinical services at UPMC CancerCenter. “By taking part in this pilot, we believe that UPMC CancerCenter can also play a leading role in developing a model for affordable, high-quality cancer care that can be replicated across the country.”
The UPMC Health Plan is supporting the new model through its own incentives and support services, part of a systemwide effort to transform the delivery of care.
“The UPMC Health Plan, as part of an integrated delivery system, is committed to partnering with CMS to demonstrate how value-based cancer care can improve quality and effectiveness for our members,” said Stephen Perkins, MD, chief medical officer of commercial and Medicare services for the UPMC Health Plan.
Cancer is one of the most common diseases in the United States, with more than 1.6 million individuals receiving a cancer diagnosis each year. According to CMS, a large majority of those diagnosed are over 65 and are Medicare beneficiaries.
To participate in the OCM, oncology providers and insurers must meet multiple requirements, including robust patient navigation, advanced use of an electronic health record, round-the-clock access to clinicians and enhanced outcomes reporting.
The UPMC CancerCenter already meets the majority of the requirements and is enhancing programs to ensure patients receive well-coordinated cancer care. Every cancer patient will receive a detailed cancer care plan to guide his or her treatment. This will cover diagnosis, treatment goals, quality-of-life considerations, care coordination and psychosocial concerns. Following treatment, patients will be provided a survivorship care plan, which includes a summary of treatment delivered and ongoing care, schedules for future visits and testing, as well as management of treatment-related effects. OHA is also improving a nurse triage function and implementing additional management tools to reduce unnecessary hospitalizations and emergency room visits.
The names of the practices and payers participating in the OCM, and more information about the model, can be found on the model’s website: http://innovation.cms.gov/initiatives/Oncology-Care/. The Oncology Care Model begins on July 1 and runs through June 30, 2021.