Healthcare coverage through value-based models is increasing, with both Centers for Medicare & Medicaid Services (CMS) and Commercial Payers implementing new payment models. These payment models were designed to encourage clinicians to treat patients cost-effectively without compromising quality.
Numerous models are in use today with the Oncology Care Model (OCM) and Merit Based Incentive Payments System (MIPS) used most often in oncology practices.
Utilization of Value-Based Care Models in Oncology*
Over time, the weighting of the factors that impact provider payments will shift. For example, in MIPS, by 2022, controlling costs will be equal to quality in determining reimbursement .
*From a survey of 530 community oncologists in early 2019.
Joszt L. Value-based care is changing cancer treatment decisions as drug costs continue to rise. AJMC.com Newsroom. https://www.ajmc.com/newsroom/valuebased-care-is-changing-cancer-treatment-decisions-as-drug-costs-continue-to-rise. Published March 31, 2019. Accessed February 10, 2020.
O'Brien D. MIPS 2020: Complete Guide. Able Health Blog. https://ablehealth.com/2019/07/30/everything-you-need-to-know-about-mips-2020/ Published July 30, 2019. Accessed February 10, 2020.