The Oncology Care Model—Why It Works and Why It Could Work Better: Accounting for Novel Therapies in Value-Based Payment

Value-based payment models (VBPMs) have become increasingly prevalent in oncology. The most robust example is the Oncology Care Model (OCM), a cancer-specific, 5-year experimental VBPM implemented by the Center for Medicare & Medicaid Innovation (CMMI). Medical oncologists participating in the OCM are held accountable for the total cost of 6-month episodes of care for patients with cancer receiving antineoplastic therapies. These costs are compared with target costs partially derived from historical cancer care spending measured during a baseline period spanning 2012 to 2015.¹ This accountability, along with Monthly Enhanced Oncology Services (MEOS) payments, is intended to foster care coordination to reduce preventable emergency department visits, inpatient hospitalizations, and inpatient postacute care.