UNDERSTANDING THE ONCOLOGY CARE MODEL (OCM) 1 © 2016 Community Oncology Alliance

What does it all mean? 2 © 2015 Community Oncology Alliance

July 30, 1965 – President Lyndon B Johnson signed H.R – aka Medicare December 8, 2003 – President George W. Bush signed the Medicare Modernization Act March 23, 2010 – President Barack Obama signed the Patient Protection and Affordable Care Act – aka health reform Background:

Congress created the CMS Innovation Center for the purpose of testing “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.” Background:

The Oncology Medical Home— Beyond Clinical Pathways

Latest Decision for Our Team 7 © 2015 Community Oncology Alliance Oncology Care Model (OCM) Merit-based Incentive Payment System (MIPS)

OCMMIPS Oncology onlyALL Physicians Guidelines are finalStill being finalized Had to apply and be acceptedAutomatic Requires oncology work flow changesRequires participation in processes Financial assistance for flow changesNO financial assistance Emphasizes cost savingsEmphasizes quality measures Can keep some savings above targetsSubject to how others perform Could be exempt from MIPSAlternative Payment Models Exempt Maximum benefit = 20%Potential +/- 9% adjustment 5 years8 years or more Can back out at anytimeCan NOT back out OCM vs MIPS 8 © 2015 Community Oncology Alliance

Medicare OCM Implementation Plan 9 © 2015 Community Oncology Alliance

Immediate: 1. Conduct a self assessment 2. Budget for changes (staff and other) 3. Model changes with reimbursement changes 4. Organize and educate entire team 5. Join peer support groups (e.g. Community Oncology Alliance OCM Network) OCM Implementation Plan – Summary

Develop plan for from self assessment Key areas: 1. Expanded access 2. IOM Care Management Plan 3. Continuous Quality Improvement 4. Patient navigation 5. Status of current and future measures 6. Validate measure data OCM Implementation Plan – Summary

Signed Participation Agreement is due June 10 th, 2016 by 5:00 pm ET Start date – Friday, July 1 st, 2016 Key Dates

QUESTIONS?