CareJourney projected payments under the new OCF criteria using 2019 Medicare Claims data. The dashboard includes three key analyses, (1) Performance Based Payment (PBP) Average Cost of Episode by Patient Segmentation and State, (2) Monthly Population Payment (MPP) Measures, and (3) PBP Measures. Read more about OCF here!
Analysis 1: PBP Average Cost of Episode by Patient Segmentation and State
Frequently Asked Questions
Q: What is the difference between PBP and MPP?
A: MPP is a fixed capitated payment that provides OCF practices a set sum for E&M services rendered by a medical oncologist. This sum is calculated based on the practice’s full Medicare population and includes patients who are treated with chemotherapy and those that are not.[1]
PBP mirrors the performance payments in Oncology Care Model (OCM). The payment holds OCM practices responsible for the total cost of care (including drugs) across a patient’s six-month episodes. With this payment, if practices see total costs of care below the benchmark (both from a cost and quality perspective), then they receive the PBP. On the other hand, if practices exceed the benchmark, then they owe CMS a PBP recoupment. For the PBP, an episode is triggered by chemotherapy and only applicable for beneficiaries enrolled in Part B or Part D Medicare fee-for-service. [1]
Q: What are the eligibility criteria for participating in OCF?
A: Similar to OCM, to participate in the model, practices must: [2]
Q: When assessing OCF PBP, what are the key points I should take into consider?
A: OCF PBP episode payments differ by state, but this does not appear to be related to the state’s total number of episodes. OCF PBP episode payments differ by frailty segmentation. Want to learn more about OCF PBP? Read our blog post here!
Q: This dashboard only presents data at the practice group level. I want to explore these OCF measures at the individual provider level. What do I do?
A: Please reach out to CareJourney at jumpstart@carejourney.com.
Q: I am interested in finding out high-performing oncology practice groups and providers to better assess my readiness in OCF. What do I do?
A: CareJourney’s Provider Performance Index adopts evidence-based methodologies to benchmark providers from cost and quality perspectives. Interested in learning more? Please reach out to jumpstart@carejourney.com.
More Questions?
Should you have any additional questions, please reach out to your main point of contact at CareJourney for more information and/or additional support regarding this analysis. If you do not have a main point of contact at CareJourney, please reach out to jumpstart@carejourney.com.
CareJourney is a leading provider of clinically-relevant analytics for value-based networks supporting leading payer, provider, and life sciences organizations across the US. We help these organizations achieve their goals by bringing new, high value insights out of expansive population claims data.
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[2] Oncology Care First Model: Informal Request for Information; CMMI outlines potential next steps in oncology payment reform—the Oncology Care First Model; Community Needs More Time to Assess and Comment on CMMI’s Proposed Oncology Care First Model