Publication

The Centers for Medicare & Medicaid Innovation (CMMI) released the draft for Oncology Care
First (OCF), a new oncology payment model which launched in January 2021 as the successor to CMMI’s Oncology Care Model (OCM). OCF affirms CMMI’s commitment to shift away from the status quo fee-for-service (FFS) payment paradigm to one that incents value-oriented, patient-centered care and builds on OCM. OCF, as it is currently conceived, meets CMMI’s stated goal of having a single alternative payment model (APM) dedicated to managing cost and quality for Medicare cancer patients.

CMMI’s announcements of OCF and other primary- and specialty-care payment models have raised questions on what the end state for oncology APMs looks like. This question was top of mind for members of the oncology APMs advisory council, which gathered in November 2019 in Washington, DC, for its third meeting. The council, launched in late 2017, gives leading designers and implementers of oncology APMs the opportunity to learn from one another and catalyze new thinking and approaches to improve pilots in this space.4 Participants addressed several perennial issues, including accountability and risk, the cost of drugs, meaningful outcomes measurement, and the utility of emerging tools such as electronic patient-reported outcomes (e-PROs). These challenges continue to underlie conversations in this space, as do the implications of the one-size-fits-all approach to oncology payment reform for Medicare that CMMI is spearheading through its OCF proposal.

During the meeting, participants considered the following topics:

•  Challenges presented by the coexistence of oncology and primary-care APMs
• Acceptable risk and risk mitigation strategies for practices
• The cost of drugs in APMs
• The end state of oncology APMs
• New perspectives on oncology APMs: self-ensured employers and patients