CMS OCM Pilot

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The Center for Medicare and Medicaid Innovations (CMMI) has begun piloting a program to drive oncology focuses on navigation with coordination of care in practices. The Oncology Care Management program pays an oncologist $160 per eligible member per month to manage the care of Medicare members, with each active treatment window set for six months.

Saisystems Health acts as a partner for providers who wish to take part, but do not want to exhaust current staff and systems. We offer a pilot program different from our custom oncology care management that meets all CMS reporting requirements, including NCQA Care Management Standards. Our CMS OCM design directly addresses the organization’s triple aim of better care, better health and lower costs through improved quality.

Additionally, Saisystems Health aligns with the CMS focus on four aspects of cancer treatment:

  • Episode-based care

  • Practice transformation

  • Multi-payer model

  • Performance-based payment


The goals of this program are to utilize aligned financial incentives to improve care coordination, appropriateness of care and access for beneficiaries. These incentives encourage practices to collaboratively and comprehensively address the complex needs of beneficiaries receiving treatment, as well as encourage the use of services to improve health outcomes.

For reference information on the Center of Medicare and Medicaid Services CMS OCM program, please click here.

Outcomes

  • 42% Reduction in ER visits

  • 52% Decrease in hospital admits

  • 8x National average for hospice conversion