Humana launched a new payment model for Medicare Advantage and commercial members receiving treatment for cancer, the Louisville, Ky.-based insurer announced Tuesday.
The program, called the Oncology Model of Care, will offer additional payment to participating cancer practices for improved performance on certain metrics over a one-year period. There are currently 16 practices participating in the model, which started in January.
"The experience for cancer care is fragmented," said Dr. Bryan Loy, corporate medical director of Humana's oncology, laboratory and personalized medicine strategies group. "Humana wants to improve the patient experience and health outcomes for members. We are looking to make sure the care is coordinated."
The Center for Medicare and Medicaid Innovation currently has a payment model for oncology care but it's episode-based and focuses on appropriateness of chemotherapy treatment. Commercial payers are involved in the model. HHS Secretary Alex Azar also said in November that the CMS would launch a mandatory payment model for Medicare cancer patients but it hasn't yet been announced.
Humana will be looking at several measures to determine quality of cancer care at the practices including inpatient admissions, emergency room visits, medications ordered and education provided to patients on their illness and treatment.
"We're interested in making sure that education and important issues are part of shared decision-making discussions, and that the patient understands what to expect and what to do with regard to a side effect of a particular drug," Loy said.
Humana has paid each participating practice a care coordination fee that is used to help them implement the reporting requirements and infrastructure for the model. The practices that improve their own performance over a one-year period will see the care coordination fee from Humana increase, said Julie Royalty, Humana's director of oncology and lab strategies. Practices that don't improve will receive the same care coordination fee, but their continued participation in the model will be evaluated.
Humana will also meet with the practices twice a year to go over their performance on the metrics and opportunities for improvement.
The new oncology program is Humana's fourth payment model focused on specialty care. The insurer announced last month a bundled-payment model for Medicare Advantage members who undergo spinal fusion surgery. It also has a total hip or knee joint replacement bundle as well as a maternity care bundle for commercial members.
