It’s no secret that policymakers are working to transform cancer care, shifting the basis of provider compensation from quantity of services to quality of outcomes.
Currently, more than 20% of Medicare fee-for-service payments flow through alternative payment models (APMs), putting the Department of Health and Human Services within reach of their stated goals of 30% by 2016 and 50% by 2018.
One such payment model that will start this summer is the Oncology Care Model (OCM).
Under OCM, cancer centers will be eligible to earn an additional ~$160 per Medicare beneficiary per month, plus shared savings through semi-annual performance based payments. Because many of the OCM requirements and quality measures require changes to current clinic workflow, much attention has been devoted of late to what cancer care centers need to do now to be ready to implement OCM on July 1st.
But at the end of the day, OCM is about patients. So it’s important to understand how this payment model, once implemented, will affect their experience.
Cancer patients can be OCM beneficiaries so long as they are undergoing chemotherapy treatment at one of the approximately 100+ cancer centers that have been selected to participate in OCM. While CMS has not clarified all of the details of OCM to date, connecting the dots on what we do know today indicates that the experience of being an OCM beneficiary will look like this:
1. Comprehensive care planning. OCM beneficiaries will participate with their care team to develop their personal care plan. Care plans will be comprehensive, covering such things as treatment goals, and what to expect in terms of side effects and estimated out-of-pocket costs. This means shared decision-making starting with whether to initiate chemotherapy, all the way through to decisions regarding post-treatment activities, follow-ups and surveillance.
2. Navigation support. This entails a range of patient support services, such as help managing paperwork, childcare, parking, translation services and appointment coordination for timely diagnostics and treatments, as well as personalized information on relevant clinical trials, community programs and local support groups as appropriate.
3. 24/7 access to a clinician that has real-time access to your medical records. OCM beneficiaries will be able to call their clinic anytime 24/7 and receive clinical advice from a provider that has access to their clinical record. This round-the-clock support is designed to save patients from unnecessary trips to the ER when symptoms or side effects that have gone unaddressed escalate into concerning situations.
4. Regular assessments for pain, distress and other quality of life factors. As a regular part of clinic visits, OCM beneficiaries will be asked about their pain intensity, anxiety, depression, fatigue and physical function. Practices will have a documented plan of care for addressing pain for each OCM beneficiary. And at least once during a course of chemotherapy treatment episode of care, OCM beneficiaries will receive a psychosocial screening and intervention as deemed necessary.
5. Palliative care. At least once during a course of chemotherapy treatment episode of care, OCM beneficiaries will receive a palliative care consultation.
To cancer patients, and friends or family involved in their care, this list might sound like things that one would reasonably expect now, as part of the care experience at any cancer treatment center. The reality is that while most cancer care providers would indeed like to be able to do all of these things for every patient, practices participating in OCM will be compensated accordingly. That’s a big difference, relative to what providers are compensated for today.
What it means is that instead of doing as much as they can off this list because they are compassionate and efficient, cancer centers participating in OCM will consistently provide eligible patients with every one of these services across the board. And to ensure that patients are satisfied with this experience, OCM providers will also be surveying their OCM beneficiaries on a regular basis. With these insights, practices will be able to continuously tune and optimize the OCM patient experience.
In addition, there are a variety of clinical quality measures that OCM providers will be newly compensated for achieving. These involve time spent on care coordination, enhanced communications, population health analytics and other activities centered around better patient outcomes and greater cost efficiencies.
What all this means for patients is that in essence, OCM means partnering with their providers in new and more productive ways to realize shared-decision making, more proactive care and better outcomes at less expense.
For example, OCM beneficiaries can expect their cancer center to offer user-friendly technology, such as an app or portal, that will make it easier for them to report how they are feeling (physically and otherwise) and better understand their specific disease and treatments.
At Navigating Cancer, we have learned firsthand how these types of personalized technology solutions, combined with the right practice workflow, can help patients to feel more engaged and satisfied with their care.
In summary, what should cancer patients that are OCM beneficiaries expect? A consistent and invested interest in their engagement with their care, coupled by tools and processes to enable that. In the beginning, practices may need to work out a few kinks as they bring these new tools and processes online. Ultimately, the experience of OCM promises to be one of value for practices and patients alike.