Giving Compass' Take:

• Research from the Robert Wood Johnson Foundation and the Urban Institute analyzes the Oncology Care Model developed by the Innovation Center of the Centers for Medicare & Medicaid Services.

• How can funding support the shifts identified here? What additional research is needed to clarify shared decisions in cancer care? 

• Learn how to support cancer research

The diagnosis of cancer is at once terrifying and all too common. Each year, more than 1.6 million Americans are told they have the disease, and it is already the leading cause of death among those ages 60 to 79. As the U.S. population ages, cancer diagnoses are projected to increase 45 percent by 2030.

The health care system response has taken four main approaches:

  1. improve prevention
  2. increase screening
  3. intensify research, as in the federal “Cancer Moonshot” initiative
  4. ensure better use of currently available therapies.

This fourth area, largely out of the public spotlight, is the focus of the Oncology Care Model (OCM) developed by the Innovation Center of the Centers for Medicare & Medicaid Services (CMS). The OCM, launched July 1, 2016, as a five-year experimental program, is part of a broader movement to improve care delivery by changing incentives to “pay for value.”

It changes how oncology practices are paid for providing chemotherapy, with the goal of reducing costs and improving quality...It is often difficult to tell whether chemotherapy is truly what the patients would want if they were fully informed about alternatives.

A large body of research indicates that many of the 1.7 million Americans diagnosed with cancer every year would greatly value more information-rich conversations with their doctors. Whether or not that desire for greater control over life-and death decisions saves money for third-party payers, the implementation of shared decision-making shouldn’t require a moonshot-level effort.

Medicare’s Oncology Care Model (OCM) is designed to incentivize providers to reduce unnecessary spending, improve care, and involve patients more closely in decisions about the use of chemotherapy. The model includes a 13-point care plan recommended by the Institute of Medicine (IOM) that represents a significant step toward making patients partners in their own care; in particular, it aims the volume of OCM episodes by reducing overly aggressive use of chemotherapy and underuse of hospice services among patients who are close to death. However, IOM recommendations since 1999 and recent medical literature suggest that a formal shared decision-making process (SDM) remains vitally important. This paper discusses the rationale for and barriers to adopting a more formal SDM. We recommend that SDM be added to the OCM in at least a subset of cancers and/or oncology practices before the demonstration program ends in 2021.