shutterstock_361534703.jpgMarketers in the pharmaceutical industry are no different than those in other industries: They want to understand their customer on multiple dimensions, with accuracy and ideally through low investment. However, oftentimes pharmaceutical marketers’ data sources are limited or fuzzy, and the customer can represent many diverse stakeholders. The entry of the Centers for Medicare and Medicaid Services’ new Oncology Care Model—a payment and delivery model that aims to provide higher-quality, better coordinated oncology care at the same or lower cost to Medicare—provides a clear source of providers participating in the model. Last month, the CMS’ Center for Medicare and Medicaid Innovation (CMMI) released the list of oncology practices and payers selected to participate in the Oncology Care Model. This list is publically available and contains clues as to the makeup and personality of a pharmaceutical customer. In total, 196 practices were selected and will participate in the program over the next few years—more than double what many expected and significantly more than CMMI had previously indicated that they would select. The practices that were selected have been publically enthusiastic and energized to be part of what they see as a transformative program for the delivery of cancer care in a cost-effective manner. Oftentimes, payment reform initiatives and pilots aiming to alter the way that reimbursement for care in the U.S. is delivered are met with opposition and backlash from providers. 

So why is the Oncology Care Model different? Why do providers on the model’s short list see it as a privilege and something that they’re excited to be a part of? Well, first of all, the model is for volunteers—you wouldn’t be a part of it if you hadn’t signed up. But on a more serious note, this model represents being a willing participant in an experiment that will help shape the evolution from fee-for-service to fee-for-value. Ultimately, many of these practices see their participation as an opportunity to influence what the recommendations for broader practices look like coming out of this program.


BLOG POST: Which Side Is Right About CMS' Proposed Part B Drug Reimbursement Model?

BLOG POST: Oncology Value Watchdog: What the Medicare Part B Reimbursement Model Means for Patients

The program has six requirements—or what it calls “elements”—such as 24/7 access to a triaging clinician. The elements are quite reasonable and, in fact, most relatively modernized practices have the elements in place. (Other elements include adherence to nationally recognized clinical guidelines or utilizing patient navigators within the practice.) In other words, participating may not require practices to dramatically alter their approach to care, and it gives them some leeway to experiment with how they deliver the care, as long as they can do it in a way that exceeds the benchmark financial expectations around episodic care. If the Oncology Care Model practices represent a particular provider account segment that a manufacturer should consider in a unique way, what might some of those differentiating characteristics be? Here are a few ideas.

  1. Interest in participating in a new approach to care to improve delivery outcomes
  2. Successful utilization of technological infrastructure to track outcomes (such as well-implemented electronic medical records)
  3. Motivated beyond fee-for-service, quick-win financial benefits
  4. Conscientious about the total cost of care delivery
  5. Confident that their practice can successfully “beat” the benchmarks to provide better care
  6. Equipped to coordinate across care providers within and across a health service network


Manufacturers should be prepared to partner with this segment to help them achieve their goals to successfully deliver within this model, and should be a willing, educated partner that can discuss the role of their product within episodic care as opposed to a stand-alone treatment.


Topics: oncology, First Line, Christina Corridon, CMS, Oncology Care Model, oncology value watchdog