A new payment model to improve Medicare cancer care will begin in mid-2023, the Centers for Medicare and Medicaid Services said Monday.
The voluntary program, known as the Cancer Improvement Model, builds on the Cancer Care Model, which will end on Thursday after six years. In the new model, two risk management mechanisms will be available, but both will require participants to take on some risk of loss.
The Center for Medicare and Medicaid Innovation will launch the new model on July 1, 2023 for a five-year trial period.
Participating physician group practices will be responsible for the quality of patient health and overall costs during six-month treatment episodes. Members may receive performance-based pay or be owed payback CMS if the total spend for attributed episodes exceeds a certain threshold.
Members will also be able to bill a $70 monthly premium per beneficiary if additional services are provided to eligible beneficiaries, including 24/7 physician access, patient navigation services, and social needs screening, according to CMS. news release. CMS has stated that it may require members to report social needs screening data in future model years.
CMS will pay an additional $30 per month to eligible beneficiaries, but only the base $70 will be included in episode costs. The increased monthly payment amount is lower than the monthly surcharge available in the cancer care model, but CMS said the new amount is intended to make savings easier to achieve.
Participants will also be required to provide patient demographics, including race, ethnicity, language, and gender identity. They will have to develop plans to address gaps in health equity among their patients. CMS will also require the gradual introduction of electronic patient records.
Starting Monday, teams of oncologists who treat people undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small bowel or colorectal cancer can apply. The application period ends on September 30th.
Private payers, Medicare Advantage plans, and Medicaid agencies can also apply and enter into a memorandum of understanding with CMS. The model will have one path for traditional Medicare members and another for payers for their own eligible members.
“There are dramatic disparities in the ability of people with cancer based on race, gender, region and income to access cancer screening, diagnosis and treatment,” CMS administrator Chiquita Brooks-Lasur said in a press release. “CMS is working on promoting the President [Joe] Biden’s Cancer Moonshot goals are to help Medicare cancer patients better navigate the difficult and often debilitating journey.”
Biden in February announced a goal to reduce cancer deaths by 50% in 25 years and improve the lives of people living with cancer.
In 2019, CMMI solicited feedback on a next-generation cancer care model that was due to launch in 2021 but was never released.