Future of Oncology Advanced Payment Models

Stephanie GingerPatient-centered Care, Value-based Care

The shift to value

What’s next for oncology advanced payment models? That was the topic one panel tackled at AJMC’s recent Patient Centered Oncology Care Conference. The panel represented the provider, payer, and technology perspectives. There was agreement that the Oncology Care Model, while flawed, was a good first step in redefining cancer care. Rather than churning through patients to get paid in a fee-for-service model, new payment models are seeking to more properly align incentives to reward providers for doing the right thing for the patient.

One panelist pointed out that as these new payment models are developed, providers need to get involved, gain alignment with payers and figure out what will work together rather than in separate silos.

What needs improvement

When panelists were asked what they would recommend to improve on the Oncology Care Model, there were some familiar responses. The models must consider geography, patient mix, drug prices, and expensive administrative burdens. And while it’s great to have all of the data that CMMI provides, they need it sooner to actually make it actionable. The model also must keep up with the standard care – immunotherapy is now routinely used to treat lung cancer, which was not the case when the OCM was conceived.

No one on the panel expressed confidence about two-sided risk at this point – there are just too many unknowns, including elements that are simply outside the control of the provider. There are only four buckets that have the power to reduce the cost of an episode of care:

  • Drug costs
  • Emergency department utilization
  • Hospital admissions
  • End-of-life care

Unless you can look into those four buckets and identify the amount you need to save in order to qualify for the performance payment, two-sided risk doesn’t make sense.

What’s next?

When asked about the Oncology Care First Model, CMMI’s successor to the OCM, the panelists were quick to point out they had only had the RFI for one week and it’s light on details. However, they did see encouraging signs:

  • The inclusion of all Medicare beneficiaries
  • Moving from a fee-for-service + Monthly Enhanced Oncology Services (MEOS) payment to a prospective, monthly population payment (MPP)
  • The removal of low-risk patients from the pool

However, there was concern about the lack of details – will providers be whole after the MPP? Will the model keep up with the pace of cancer treatment advances? Will interoperability be improved to reduce administrative and cost burdens?

The comment period for the OCF closes on December 13, and these panelists plan to be part of the conversation, emphasizing the importance of strong leadership at the practice level to ensure success in these new value-based care models. Risk is nerve wracking for many, but education, data and transparency will go a long way to alleviate it.

Read more about this conference.

If you need help navigating the future of value-based care, contact us today to learn more about our Patient Relationship Management digital platform and how we are helping cancer care providers gain efficiencies, reduce costs and deliver better patient care.