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For Immediate Release
Tuesday, January 27, 2015

​Contact
Press@cms.hhs.gov

​The U.S. Department of Health and Human Services (HHS) today announced a new multi-payer payment and care delivery model to support better care coordination for cancer care as part of the Department’s ongoing efforts to improve the quality of care patients receive and spend health care dollars more wisely, contributing to healthier communities. The initiative will include 24-hour access to practitioners for beneficiaries undergoing treatment and an emphasis on coordinated, person-centered care, aimed at rewarding value of care, rather than volume.

Cancer is one of the most common and devastating diseases in the United States: more than 1.6 million people are diagnosed with cancer each year in this country. According to the National Institutes of Health, cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010.

A majority of those diagnosed are over 65 years old and Medicare beneficiaries.      Continue Reading

The U.S. Department of Health and Human Services (HHS) today announced a new multi-payer payment and care delivery model to support better care coordination for cancer care as part of the Department’s ongoing efforts to improve the quality of care patients receive and spend health care dollars more wisely, contributing to healthier communities. The initiative will include 24-hour access to practitioners for beneficiaries undergoing treatment and an emphasis on coordinated, person-centered care, aimed at rewarding value of care, rather than volume.

Cancer is one of the most common and devastating diseases in the United States: more than 1.6 million people are diagnosed with cancer each year in this country. According to the National Institutes of Health, cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010. A majority of those diagnosed are over 65 years old and Medicare beneficiaries.

​​“Based on feedback from the medical, consumer and business communities, we are launching this new model of care to support clinicians’ work with their patients,” said Patrick Conway, M.D., CMS chief medical officer and deputy administrator for innovation and quality. “We aim to provide Medicare beneficiaries struggling with cancer with high-quality care around the clock and to reward doctors for the value, not volume, of care they provide. Improving the way we pay providers and deliver care to patients will result in healthier people.”

As part of the Department’s “better care, smarter spending, healthier people” approach to improving health delivery, the Oncology Care Model is one of many innovative payment and care delivery models developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and advanced by the Affordable Care Act. The model was created in response to feedback from the oncology community, patient advocates, and the private sector that a new way of paying for and delivering oncology care is needed. This model will invest in physician-led practices, allowing the practices to innovate and deliver higher-quality care to their patients. CMS is seeking the participation of other payers in the model to leverage the opportunity to transform care for oncology patients across a broader population.

The Oncology Care Model encourages participating practices to improve care and lower costs through episode-based, performance-based payments that financially incentivize high-quality, coordinated care. Participating practices will also receive monthly care management payments for each Medicare fee-for-service beneficiary during an episode to support oncology practice transformation, including the provision of comprehensive, coordinated patient care.
          
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For Immediate Release
Thursday, February 12, 2015
Contact
Press@cms.hhs.gov

Press release: New Affordable Care Act initiative to encourage better oncology care

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FOR IMMEDIATE RELEASE
September 19, 2014

Contact: HHS Press Office
202-690-6343
........              Health care law saves consumers money, provides more resources to states

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Consumers saved $1 billion in 2013 and states receive more funding to continue to scrutinize rate hikes

Health and Human Services Secretary Sylvia M. Burwell today released a new report showing that in 2013 alone, consumers benefited from $1 billion in savings from lower than originally requested health insurance rates. This includes $290 million in savings for individuals and families, and $703 million in savings for small employers. Combined with refunds consumers received because of the 80/20 rule, consumers saved more than $2.8 billion in 2012 and 2013. Secretary Burwell also announced roughly $25 million in rate review grant awards to 21 states. (see below)

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The Affordable Care Act is bringing greater scrutiny and accountability to health insurance premium increases, resulting in big savings for consumers.

Because of the law’s “rate review” provision and state efforts, consumers are continuing to benefit from lower than requested premium increases.

“Before the Affordable Care Act, consumers regularly faced significant annual premium increases,” said Secretary Burwell.

“In 2013 alone, we see that rate review programs saved consumers approximately $1 billion while providing them with the information they need to get the care they deserve.”

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Before the Affordable Care Act, annual premium increases were often in the double digits. Insurance companies were able to raise premiums without explaining their actions to regulators or the public or justifying the reasons for their high rates to consumers. Now, the law requires insurance companies in every state to publicly justify any rate increase of 10 percent or more. Consistent with previous years since the rate review provision went into effect, today’s report shows that the implemented rate increases were smaller than what was originally requested across both the individual and small group markets.

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The Affordable Care Act provides states with Health Insurance Rate Review Grants to enhance their rate review programs and bring greater transparency to the process. Today’s awards will continue to support state efforts to enhance their review of health insurance rate increases, educate consumers, help hold insurance companies accountable, and to scrutinize medical pricing data. States getting these awards include: Arizona, Arkansas, California, Delaware, Hawaii, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, Oregon, Rhode Island, Utah, Vermont, Washington, and Wisconsin. These grants are also supporting data centers that, among other activities, expand the availability of medical pricing information available to consumers, businesses, and entrepreneurs.

Rate review is one of many initiatives in the health care law aimed at saving money for consumers and it works in conjunction with the 80/20 rule. The 80/20 rule, also known as the Medical Loss Ratio (MLR) rule, requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers. The combined amount of refunds and lower than originally requested rates resulted in more than $2.8 billion in savings for consumers in 2012 and 2013.  Continue Reading

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