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Navigating the Oncology Care Model with pMD

pMD’s Care Coordination solution is empowering oncology practices to navigate new performance-based, episodic payment models for cancer care.  

In 2017, the Centers for Medicare and Medicaid Services (CMS) launched a new payment and care delivery model for the treatment of cancer patients.  The Oncology Care Model (OCM) was created to improve care quality while lowering cost by incentivizing practice redesign towards oncology care coordination. Applications were submitted to CMS, which ultimately selected nearly 200 U.S. physician practices to participate in the OCM.  The model also included 14 payers, meaning that Medicare will not be the only payer participating.  Inclusion of other payers supports the main goal of the OCM, as stated by CMS, to incentivize practice-wide care transformation, not to just improve care coordination for Medicare beneficiaries but for all oncology patients.

To participate in the OCM, practices were required to implement 6 redesign activities which included providing patients with 24/7 access to a clinician, the utilization of patient navigation and care coordination services, and the collection and analysis of data for continuous quality improvement, among others.

OCM redesign activities sought to address the challenging nature of delivering coordinated oncology care across a team of clinical and support staff. One patient’s treatment may be administered over several months.  High-risk patients may require more frequent intervention.  Oral chemotherapy patients may require timely interaction for symptom management given they receive treatment outside of the clinic, increasing the risk that patient concerns may go unreported. And post-treatment follow-up may extend over several decades.

Evolution of Care Navigation

The utilization of clinical nurse navigators supporting education and coordination as “air traffic controllers” for care is not new to oncology.  But navigator support under the OCM may now extend to manage urgent care appointment slots or to triage patients after hours all in a time when appropriate use of emergency department and or hospital resources is even more important.  

Additionally, the utilization of non-clinical navigators can greatly impact both care quality and patient satisfaction.  Duties may include support coordinating treatment appointments, facilitating communication between clinical nurse navigators, and orchestrating other patient-centric support services, including financial counseling, psychosocial programs, and patient transportation.


Image: Centers for Medicare & Medicaid Services

*There are 192 practices (List) and 14 payers participating in the Oncology Care Model

Through the OCM, CMS incentivizes practices to implement clinical and non-clinical navigation services in two ways.  First, in addition to standard fee-for-service payment, practices will receive a per-beneficiary-per-month payment (PBPM) for each six-month treatment episode that initiates with outpatient chemotherapy. And secondly, practices will also be eligible for performance-based payments based on a number of factors including managing the cost of each care episode, meeting quality requirements, and receiving high marks in patient satisfaction.  But the question remains: what is the correct level of staffing and/or intervention to produce higher-quality at a lower cost?

Data-powered Quality Improvement

An organized tracking system that easily collects information on various patient interactions across the care team is vital not only for successful implementation of the OCM but also in delivering high-quality care.

The coordination of patient-centric activity among clinical and non-clinical navigators and support staff is a need many OCM practices have identified.  Capturing patient call type, frequency, and duration plus face-to-face patient interactions provides practices the insight necessary to appropriately resource these services. Further, when patient engagement data is tied to clinical outcomes, then a model for care coordination emerges that can be copied and scaled based upon patient volume, diagnosis, and risk scoring.  And activity data further supports care quality discussions with payers.

pMD’s Care Coordination solution includes expertise and technology to help practices meet the navigation requirements of the OCM. But care coordination is vital beyond oncology and the OCM.  pMD is passionate about helping practices to manage the complexity of care delivered across specialities supporting all care communities.  If you have any questions or would like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

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