Health care has a $100 billion-plus cancer problem that’s only going to snowball as baby boomers age. But the feds hope that a new experiment, centered around better-coordinated care for patients, can help to lessen this crushing financial burden on hospitals and docs alike.
The Centers for Medicare & Medicaid Services announced Wednesday a list of hundreds who will be taking part in its innovative new approach to treating cancer patients. They include 17 commercial health insurers alongside almost 200 physician groups, several of which are affiliated with hospitals.
Participating docs from such systems as Detroit’s Henry Ford and Chicago’s Northwestern will receive incentive payments for improving quality for chemotherapy patients, along with monthly payouts to help manage care for each beneficiary, according to a news release.
As we’ve all experienced with one of our friends or relatives, cancer is an increasingly common and devastating disease. More than 1.6 million new cases will be diagnosed in the U.S. this year, the Department of Health & Human Services notes, and about 600,000 Americans will lose their lives to cancer in 2016. These numbers are only going to worsen, as the aging population is expected to increase the cost of cancer treatment by 27 percent during the decade ending in 2020, up to $158 billion, according to the National Institutes of Health.
These numbers have spelled big interest in the feds' new Oncology Care Model, with the number of participants double what CMS anticipated, according to the release.
“It’s clear that oncology physicians recognize the importance of this new performance-based, episode-based payment approach to cancer care,” Patrick Conway, M.D., chief medical officer and principal deputy administrator of CMS, said in a statement. “As a practicing physician and son of a Medicare beneficiary who died from cancer, I know the importance of well-coordinated care focused on the patient’s needs.”
CMS is asking participants to provide a slew of “enhanced services” to cancer patients during the five-year effort to assist in bringing costs down and bolstering quality. Those include better-coordinated appointments, 24/7 access to care, ensuring that test results are received prior to appointments, and offering additional resources to patients such as emotional support groups and pain management services. The feds are funding those services through a $160 per beneficiary monthly payment, while docs will also earn performance-based payments based on hitting quality measures and reducing expenditures below a target price. The program will focus on Medicare beneficiaries who receive chemo, along with the spectrum of services in the six months following that initial treatment.
As I mentioned previously, several hospital-related practices have found promise in this experiment, which kicks off on Friday — such as the University of Texas Southwestern Medical Center at Dallas, Summa Health in Akron, Ohio, and Vanderbilt University Medical Center in Nashville, Tenn. Both the health plan and physician practice of Henry Ford are taking part, too, with the goal that patients will “experience fewer treatment complications, have improved access to clinical care and care coordination services, have fewer unplanned emergency department visits and hospital admissions and enjoy better quality of life,” Robert Chapman, M.D., oncologist and project director for the initiative at the Detroit hospital network, said in a statement.
Henry Ford also just announced that it’s launching a precision medicine program, and it hopes that its participation in OCM combined with the new genomics offering will help to revolutionize cancer care for patients, according to a press release.
“The Oncology Care model offers an incredible opportunity to further enhance the care we provide to our cancer patients and Health Alliance Plan members receiving chemotherapy at Henry Ford,” Chapman says.