The Real Cost of Treating Cancer in the U.S.
Cancer is one of the most common and devastating diseases in the United States: more than 1.6 million people are diagnosed with cancer each year in this country. A significant proportion of those diagnosed with cancer are over 65 years old and are Medicare beneficiaries. Each year, cancer is responsible for the death of an estimated 600,000 Americans. The cost of cancer care reached at least $158 billion in 2020—an increase of 27% since 2010. The high cost of cancer treatment has left many patients and their families devastated by the expense, prompting a shift toward a value-based care system.
The Oncology Care Model: Value-Based Care for Better Treatment and Lower Costs
The Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is furthering its goals of improved quality of care at the same or lower cost through an innovative oncology payment model, the Oncology Care Model (OCM). OCM is part of the larger U.S. health care movement towards paying providers based on the quality, rather than the quantity of care they give patients. The Oncology Care Model aims to ensure appropriate, high quality clinical cancer care throughout chemotherapy treatment sessions while reducing costs and improving health.
OCM is a 6-year value-based care model that began on July 1, 2016 and runs through June 30, 2022. OCM was CMS’s first value-based, episode-based specialty care payment model. Under OCM, physician group practices have entered payment arrangements that include financial and performance accountability for 6-month episodes of chemotherapy for Medicare beneficiaries with cancer. The Oncology Care Model currently includes:
- Approximately 130 participating chemotherapy centers that cover urban, suburban, and rural areas (See Figure 1)
- Practices that range in size from solo oncologists to large practices with hundreds of providers
- Chemotherapy centers participating in the OCM that are held accountable to:
- Provide enhanced patient navigation and care coordination services
- Increase patient access to providers 24 hours a day, 7 days a week
- Have conversations with their patients about the expected total cost of care for their cancer treatment
- Document that they provide cancer treatment that meets nationally recognized clinical guidelines
- Use data to drive continuous quality improvement.
Figure 1: Geographic Diversity of Participating OCM Cancer Centers