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New Affordable Care Act Initiative Aims to Improve Cancer Care and Cut Costs

Today, the US Department of Health and Human Services (HHS) announced a cancer care initiative for Medicare beneficiaries that will link payments to oncology practices to quality of care and patient outcomes.

The New Affordable Care Act initiative, by the Centers for Medicare and Medicaid Services (CMS), is in support of the ongoing effort to improve the quality of care patients receive and spend health care dollars more wisely. The initiative will include 24-hour access to practitioners for beneficiaries undergoing treatment and an emphasis on coordinated, person-centered care, aimed at awarding value of care, rather than volume.

“Based on feedback from the medical, consumer and business communities, we are launching this new model of care to support clinicians’ work with their patients,” said Dr. Patrick Conway, chief medical officer of CMS. “We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide. Improving the way we pay providers and deliver care to patients will result in healthier people.”

Cancer is one of the most common and devastating diseases in the US, with more than 1.6 million Americans diagnosed with the disease each year. The National Institutes of Health (NIH) estimated that cancer cost the US $263.8 billion in medical costs and lost productivity in 2010. The majority of individuals diagnosed are over 65 years old and Medicare beneficiaries.

CMS said it has determined that a new way of paying for and delivering cancer care is needed. CMS Innovation Center developed the Oncology Care Model as an innovative payment and care delivery model, created in response to feedback from the oncology community. The model will invest in physician-led practices. The Oncology Care Model encourages participating practices to improve care and lower costs through episode-based, performance-based payments that financially incentivize high-quality, coordinate care. Practices that participate will also receive monthly care management payments for each Medicare fee-for-service beneficiary during an episode to support oncology practice transformation.

The HHS is focused on three areas including linking payment to quality of care, improving and innovating in care delivery, and sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy.

“With the Oncology Care Model, CMS has the opportunity to achieve three goals in the care of this medically complex population who are facing a cancer diagnosis: better care, smarter spending, and healthier people,” said Dr. Conway. “As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinate care focused on the patient’s needs.”

CMS hopes to broaden the initiative to include a larger portion of the population through participation of Medicaid programs and non-government payers. Physician group practices and solo practitioners that provide chemotherapy for cancer and are enrolled in Medicare may apply to participate.

Source: Centers for Medicare & Medicaid Services

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