Main Library
Incorporating clinical data into risk stratification could improve the accuracy of CMS bundled payment models like the Oncology Care Model (OCM), according to a new Avalere analysis.
The OCM is a bundled payment model that evaluates the total cost of care for episodes initiated by chemotherapy treatments within six-month performance periods (PP). At the end of each period, CMS measures practice performance by comparing total expenditures to a benchmark price predicted by factors like tumor type, comorbidities, member demographics, and utilization of certain services.
Participating practices that stay within the benchmark price earn a performance-based payment (PBP) and those that exceed the benchmark owe CMS recoupment.