The Oncology Care Model and Compliance with NCCN Guidelines®

The Oncology Care Model (OCM) presents health care providers with certain challenges. In particular, they must demonstrate compliance with recommendations from the National Comprehensive Cancer Network® (NCCN®) as published in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). As healthcare reimbursement systems trend toward the Oncology Care Model, stakeholders in all related fields need to understand this new paradigm.

What is the Oncology Care Model (OCM)?

The Center for Medicare & Medicaid Innovation (CMMI) has recently introduced new specialty care payment/delivery systems, including the Oncology Care Model. CMMI created the OCM to offer higher quality, coordinated care to oncology patients while maintaining or reducing Medicare costs.

Physician practices that participate in the Oncology Care Model commit to offering higher-quality services to Medicare patients, such as compliance with national treatment guidelines and care coordination. They enter into financial contracts that hold physicians accountable for cancer patient care, especially the administration of chemotherapy. As government payers push for closer alignment with value-based patient care reimbursement, the entire healthcare landscape shifts with them.

How Will the Oncology Care Model Affect the U.S. Healthcare Industry?

Healthcare reimbursement systems increasingly trend toward methods like the Oncology Care Model. When the U.S. Congress created the CMS Innovation Center, they tasked it to “…[test] innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care.” This major player in the U.S. healthcare sector leads the way in advocating for cost controls and patient care.

The federal government spends over $500 billion each year on health care, more than any other U.S. organization. For this reason, Medicare and have the clout to demand better accountability and patient care from healthcare providers.

As one of the first value-based reimbursement models, the Oncology Care Model changes the face of healthcare financing. According to CMS, fourteen private healthcare companies have jumped on the OCM bandwagon. In cases like these, private payers typically follow the lead of large governmental payers. (However, they enjoy some flexibility in creating incentives while remaining in alignment with CMS guidelines.)

The Importance of NCCN®

The NCCN Guidelines® are the recognized standard for clinical policy in cancer care and are the most thorough and most frequently updated clinical practice guidelines available in any area of medicine. Providers must attest to have followed the NCCN Guidelines to get reimbursements under the Oncology Care Model. As the only nationally recognized standard, the NCCN Guidelines provide front-line advocacy and accountability for cancer patients.

How Evinance Can Help

Evinance allows doctors and patients to visualize each patient’s journey through the NCCN Guidelines to ensure doctors and patients make the best decision together. With real-time compliance tracking for every patient, providers can easily attest to following nationally recognized standards. And as the standard of care continues to evolve at an ever-increasing rate, providers have the peace of mind knowing that Evinance will always make these updates available in a timely manner.

Providers are also able to define their institutional pathways through the NCCN Guidelines in minutes, ensuring recommended treatments always reflect how they manage care. For example, an NCCN Guideline may include 10 Neoadjuvant Chemotherapy Regimens; however, an institution may only offer 7 of these. So providers have a lot of flexibility in how they define their pathways while ensuring compliance with NCCN Guidelines.

Evinance seamlessly integrates into existing healthcare workflows and gives clinicians direct decision support access in their Electronic Health Record (EHR) system.

Oncology patients can trust physicians who use the Evinance platform to treat them according to NCCN recommendations. With the best knowledge and standards at their fingertips, clinicians can provide quality care that aligns with the most recent scientific evidence. Evinance helps doctors teach patients and families what they need to know to make the best possible decisions about their cancer treatments. And in the end, patients avoid the discomfort, hassle, and cost of unnecessary treatments and tests that don’t improve outcomes.

According to Chad Armstrong, Evinance CEO, “Our collaboration with NCCN will ensure the latest evidence-based clinical recommendations are always available at the point of care, enabling better communication with patients.” The Oncology Care Model is one of the first reimbursement programs requiring adherence to nationally recognized guidelines, but many others will soon follow. Evinance helps providers transition and succeed under these new value-based care models. By spending less time sorting through irrelevant data and more time consulting with patients, oncologists can dramatically reduce costs and facilitate better patient outcomes than ever before.

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