The Case of Bundled Payments in Oncology Care Model

1

• The Case of Bundled Payments in Oncology Care
  Model

2
The Case of Bundled Payments in Oncology Care
Model

• 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.
• Research revealed that many organizations are
  experimenting with value-based payment models
  that aim to balance the competing goals of
  controlling costs and allowing access to advances
  in treatment.
• 4 value-based payment models are being tested in
  the commercial market
• Financial incentives for adhering to clinical
  pathways
• Patient-centered medical homes
• Bundled payments
• Specialty accountable care organizations
• In addition, CMS recently launched the Oncology
  Care Model, a 2-part payment system, resembling a
  PCMH and a bundled payment model. Many of these
  models target drug spending. A common element in
  all the value-based reimbursement models for
  oncology was a drug spending reduction goal. The
  models aimed to decrease prescription drug
  spending and utilization because medication costs
  represented the greatest cancer episode cost.

Medical Billing Services in Oregon
3
The Case of Bundled Payments in Oncology Care
Model

• Providers engaging with the model had to adhere
  to the pathway between 70 and 85 percent of the
  time to qualify for financial incentives. The
  adherence range also gave providers flexibility
  for necessary care variations based on patient
  characteristics, preferences, and new treatments.
• The clinical pathway model generated significant
  healthcare cost declines, especially for drug
  spending and healthcare utilization. Drug costs
  decreased between 5 and 38.
• Reduced toxicity also resulted in 7 to 42 less
  emergency department visits and 7 to 38 fewer
  hospital admissions.
• Bundled payments also emerged as a common method
  for reducing cancer care costs. Most interviewees
  participating in bundled payment models stated
  that drug costs were part of the bundle which
  covered services anywhere between 1 -2 years.
• The oncology bundled payment models resulted in
  the following cost and utilization reductions
• 32 less emergency room visits
• 19 decrease in inpatient days
• Drug spending stabilization after a historic
  increase between 16 and 19 per year

Medical Billing Services in Oregon
4
The Case of Bundled Payments in Oncology Care
Model
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 havent yet should look to
invest in bundled payment models to improve the
quality of care and reduce spending. Effects of
Oncology Care 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. The providers that are seeking
consulting services from MEDISYS to succeed in
this particular bundled payment program can
connect with their representative. MEDISYS help
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.
Medical Billing Services in Oregon