N※N

Portland Central Maine Comprehensive Cancer Center | News, Weather, Sports, Breaking News

  //sports-competition.news-articles.net/content/2 .. er-center-news-weather-sports-breaking-news.html
  Published in Sports and Competition on Monday, September 1st 2025 at 9:41 GMT by WGME
          ^{🞛 This publication is a summary or evaluation of another publication 🞛 This publication contains editorial commentary or bias from the source}

How Medicare’s New Cancer Care Model Will Change the Way Patients Get Treated

The recent health‑care update from Westgate Media’s “Health Matters” section outlines the launch of a new Medicare program that promises to reshape oncology care across the United States. The initiative—referred to in the article as the CMMI Oncology Program—is part of the Centers for Medicare & Medicaid Innovation’s (CMMI) effort to bring a value‑based framework to cancer treatment. While the program is still in its early stages, the article explains how it will affect doctors, hospitals, and patients, and what stakeholders need to know to prepare for its rollout.

1. What is the CMMI Oncology Program?

The CMS (Centers for Medicare & Medicaid Services) has been experimenting with alternative payment models for years. In 2023, it introduced the Cancer Care Model (CCM) under the umbrella of CMMI. The goal is straightforward: encourage high‑quality, coordinated care for Medicare beneficiaries who are newly diagnosed with certain cancers, while keeping costs predictable for the program and ultimately reducing overall spending.

The model works much like other CMMI initiatives. Instead of the fee‑for‑service approach that pays doctors and hospitals for each individual service, the CCM shifts the focus to the whole episode of care. Providers who join the program receive a pre‑approved payment to cover a wide range of services over a defined period, typically 12 months after diagnosis. In exchange, they agree to meet quality metrics, improve patient experience, and use data analytics to identify gaps in care.

2. Who Will be Covered?

Initially, the CCM targets Medicare patients with the following cancers:

• Non‑small cell lung cancer (NSCLC)
• Breast cancer (any stage)
• Colorectal cancer (stage I‑IV)
• Pancreatic cancer
• Kidney cancer

Patients must be enrolled in Medicare Part A and Part B and meet other eligibility criteria such as having a newly diagnosed cancer that has not been treated previously. The CMS website (linked in the article) details the exact eligibility rules and lists the ICD‑10 codes that trigger the program.

3. How Does Payment Work?

Under the CCM, participating providers receive a capitation payment—a set amount per member per month (PMPM). This figure is determined by CMS based on historical spending, risk adjustment, and the complexity of the patient’s cancer. The payment is intended to cover:

• Diagnostic work‑up (biopsies, imaging)
• Initial treatment (surgery, radiation, chemotherapy)
• Follow‑up care (monitoring, supportive services)
• Palliative care if needed

Because the payment is bundled, providers are incentivized to eliminate unnecessary procedures and coordinate care more efficiently. At the same time, they retain a share of the savings if they can deliver care at lower cost than the bundled payment. If they exceed the bundled amount, they may receive a “risk” payment, making the model more appealing to high‑volume oncology practices.

4. Quality Metrics and Patient Experience

The article highlights that the CCM uses a mix of clinical and patient‑reported metrics. Clinical measures include:

• Time from diagnosis to first treatment (aiming for within 30 days)
• Survival rates at one year for eligible cancers
• Hospital readmission rates within 30 days of discharge

Patient‑reported measures come from the CMS Value‑Based Purchasing (VBP) survey and the Patient‑Centered Outcomes Research Institute (PCORI) tool. These capture how patients feel about the care they receive—communication, coordination, and overall satisfaction.

Providers who perform well on these metrics can earn bonuses, while those who fall short risk penalties. CMS will release quarterly performance dashboards that will be publicly accessible, ensuring transparency.

5. What the Program Means for Doctors and Hospitals

The “Health Matters” article quotes Dr. Elena Ramirez, an oncologist at St. Mary’s Medical Center, who explains that the CCM offers an opportunity for clinics to streamline processes. “Because we’re looking at the entire care episode, we can identify which tests or treatments aren’t adding value,” she says. “We can cut unnecessary steps and focus on what truly benefits the patient.”

Hospitals are encouraged to partner with community oncology practices to create an integrated care team. According to the article, the program will fund care‑coordinator roles—often filled by nurses or pharmacists—to keep patients on schedule for appointments and medication refills.

The model also brings financial stability. For many practices that historically struggled with the unpredictability of fee‑for‑service payments, the bundled payment can smooth revenue streams, especially if they successfully manage the risk of exceeding the payment.

6. Challenges and Risks

The article notes several hurdles that participants must navigate:

• Administrative Burden: Providers must set up data‑exchange infrastructure to feed CMS with real‑time information. Smaller practices may need external support to comply with reporting requirements.

• Risk of Under‑Treatment: If a provider cuts corners to stay within the bundled payment, patient outcomes could suffer. CMS monitors this through the quality metrics, but the early stages of the program will test how providers balance cost and quality.

• Patient Enrollment Timing: Patients who already began treatment before the CCM’s start date are ineligible, which can limit early adoption for certain cases.

• Equity Concerns: The article raises the question of whether the program will address disparities. CMS has pledged that the model will apply to all Medicare beneficiaries, but real‑world data will reveal whether underserved populations receive the same benefits.

7. How to Get Involved

The article provides clear steps for interested practices:

1. Sign up on the CMS CMMI portal – The registration link is included in the article.
2. Complete the onboarding training – CMS offers webinars covering data capture, billing, and quality reporting.
3. Form a multidisciplinary team – Involve surgeons, radiation oncologists, pharmacists, and care coordinators.
4. Set baseline metrics – Establish pre‑program benchmarks to compare against later performance.

CMS will open enrollment for the next cohort in early 2025, and the article urges readers to contact their local Medicare administrative contractor for more details.

8. What Patients Can Expect

For patients, the CCM promises a more coordinated experience. The article highlights that patients will receive a single, dedicated care team that manages appointments, tests, and follow‑up. This reduces the need for patients to navigate multiple billing codes or insurance authorizations. Moreover, because the program rewards improved patient experience, there is a higher likelihood that patients will feel heard and more engaged in their treatment decisions.

9. Looking Ahead

As CMS continues to refine the model, the article cautions that the ultimate impact on cancer outcomes remains to be seen. The next few years will reveal whether a bundled payment structure can indeed reduce costs without compromising care quality.

In the meantime, stakeholders—including physicians, hospitals, payers, and patients—should stay informed. The “Health Matters” piece ends with a reminder that the program’s official resources—such as the CMS CMMI oncology web page, the Value‑Based Purchasing dashboard, and the Centers for Medicare & Medicaid Innovation’s informational videos—are essential for anyone wanting to understand the nuances of the CCM.

In Sum

The CMMI Oncology Program represents a bold shift from traditional fee‑for‑service to a value‑based, episode‑of‑care model for Medicare patients newly diagnosed with certain cancers. By bundling payments, setting rigorous quality metrics, and encouraging care coordination, the program aims to deliver better outcomes at lower costs. While the potential benefits are clear, the success of the model will hinge on how providers manage administrative demands, meet quality thresholds, and ensure equitable access for all patients. For now, the program remains in its infancy, but the “Health Matters” article offers a comprehensive snapshot of what’s to come and how to prepare for it.