Support for ePROs in Oncology Care First Model

by | Feb 10, 2020 | News, Oncology Care Model

Earlier this month, Dr. Ethan Basch, Dr. Lalan Wilfong, and Dr. Deborah Schrag joined forces to publish an editorial for JAMA to express their support for the inclusion of electronic patient-reported outcome (ePRO) collection to the Oncology Care First (OCF) model set to replace the Oncology Care Model (OCM) in 2021. 

While the OCF is building on the OCM and maintaining many of the same attributes, the informal Request for Information (RFI) suggested some adjustments to this new model based on learnings from the OCM. In this post we break down some of the key points from the authors’ editorial and share key quotes. 

Patient-reported outcomes are important in cancer care

The proposed addition of ePROs as a practice redesign activity in the OCF has garnered considerable attention since the proposed model was announced in November 2019. Basch, Wilfong, and Schrag published their viewpoint to underscore both why ePROs are necessary for a new oncology model and how to approach the challenges that are inevitable when introducing something new into the care model. Dr. Basch and Dr. Schrag have published papers demonstrating the use of and the positive results of PROs in routine cancer. Encouraging more practices to use ePROs through gradual adopting in the OCF model could help prove the success of ePROs in the real-world setting.  

The authors also make the case that PRO data has a multi-faceted use in oncology care. PRO data obviously has a clear line to helping patients through symptom management during reporting of acute episodes. However, PRO data can also provide context and details around drug development such as comparative-effectiveness research, quality assessment, and more. PRO data allows physicians to better understand their patients as individuals and as populations.

“This gap prevents clinicians from answering fundamental questions patients want to know when making a treatment decision: ‘How much better do patients like me feel with this treatment?’ or its corollary, ‘How poorly do patients like me typically feel?’”

Despite the positive potential of ePROs in cancer care, there are concerns that must be addressed. The authors discuss the issues that arose during the CMS listening session for the proposed OCF. Some of the main concerns are around adequate patient participation and engagement, workflow integration at the practice, cost implications, and other logistical challenges. Rural practices are also concerned about lack of internet access for some of their patients.

ePRO collection is a new territory for many physicians, which is why it is important the expectation from CMS focus on gradual implementation. Practices will need time to ensure they have the tools and resources to engage patients as well as the proper integration and training for their care teams. 

As we saw in the recent survey data released by the Community Oncology Alliance, a significant number of responding clinics indicated they would choose 2-sided risk to stay in the OCM. Practices have invested a lot of time and money to try to meet OCM expectations, and many that did not achieve a performance payment still chose to move to risk instead of dropping out of the model. Not only is this a good indicator of practice engagement and investment, but it will help these practices prepare for when they may choose to participate in the OCF and, if the current proposal holds, they will be required to take on risk immediately. 

Practices will need coaching and guidance if implementation of PROs is mandated in the OCF. They may also need a reliable partner in developing and implementing ePROs into their workflow and patient engagement plan. 

We’re already helping practices capture and act on PRO data

Our patient relationship management solution at Navigating Cancer helps practices transform their cancer care to help improve patient care and outcomes. In 2019, Navigating Cancer practices captured PRO data for 91,000 unique patients. Data was collected from 35 clinics across 49 states. PROs collected included symptom management as well as assessments on depression, pain, and distress. 

Practices that have implemented our Care Management solution have seen a decrease in symptom incident resolution time. Health Tracker, our patient monitoring program, helps patients stay connected to their care teams outside the office through regular check ins. Curious what some of our practices already using Health Tracker are saying? Check out this post for some insights and what future improvements look like. 

Want to learn more about how Navigating Cancer can help you implement ePROs into your practice? Contact us today!

“Although it may take several iterations to get the details worked out, this bold step lays the groundwork for aligning reimbursement with patients’ well-being. In addition, adoption of systems that reward clinicians who track and react to symptoms could have spillover effects to patients who are not covered by Medicare, and to those with chronic conditions beyond cancer.”