Boost your practice’s value-based care model and earn rewards when you help reduce the total cost of care. The Cancer Episode Program is a voluntary bundled payment program that modifies the standard fee-for-service payment system with a prospective, episode-based bundled payment (or episode fee) for 4 months of outpatient treatment.
Once your practice is enrolled in the program and the contract amendment is in place, much of the workflow is automated1:
Prospective episode fee: Covers 4 months of outpatient cancer care and includes:
Intravenous/injectable chemotherapy and supportive care drugs: Paid at 100% of the average sales price (ASP). All other services are reimbursed according to your existing fee-for-service contract.
The episode fee is renewable based on the cancer type and stage:
An annual shared savings payment is made if you help reduce the total cost of care by meeting performance measures, shared savings criteria and targets.1