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December 20, 2018

The Oncology Care Model and Other Value-Based Payment Models in Cancer Care

Author Affiliations
  • 1Division of Gynecologic Oncology, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Tennessee Oncology, OneOncology, Nashville
  • 3Department of Medicine, Division of Healthcare Delivery Science and Innovation, Weill Cornell Medicine, New York, New York
JAMA Oncol. Published online December 20, 2018. doi:10.1001/jamaoncol.2018.5735

Two years have passed since the Oncology Care Model (OCM), Medicare’s first cancer-specific alternative payment model, was officially launched with more than 190 participating practices. On this anniversary, we found it timely to compare the OCM with other value-based payment models (VBPMs) that have faced executional challenges in such a heterogeneously complex specialty as cancer.

Great enthusiasm to test innovative VBPMs exists in oncology. In a large systematic review,1 we found multiple examples of different payment and delivery models in cancer care, including bundled (or episode-based) payments, Accountable Care Organizations (ACOs), and oncology medical homes. Before comparing the OCM with these other models, it is important to define each of them. Bundled payments replace fee-for-service (FFS) payments with a fixed payment for a previously agreed set of services. In an ACO, clinicians are still reimbursed via FFS, but they have the potential for shared savings or losses based on their financial performance relative to previous years and regional benchmarks. A medical home is a health care delivery model that adheres to standards set by the National Committee for Quality Assurance and receives funding to support care enhancements in addition to FFS payments.

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