On December 9th, I had the opportunity to listen to a webinar hosted by the ASCO publication Journal of Oncology Practice (JOP) on the topic of oncology payment reform – a healthcare topic that has received a lot of attention lately. Approximately 800 participants listened to the webinar that covered this complex subject. I will share some of the points that stood out to me.
Political/Policy Imperatives to Change Payment in Oncology: Dr. Kavita Patel, MD (Brookings): Dr. Patel talks about the unmet needs in cancer care and the fact that the current fee-for-service (FFS) model doesn’t meet those needs. She went on to review the pros and cons of the key new payment models being tested in oncology. Some of the new models are still based on FFS. The key imperatives that apply to all of the models are: timely and useful data sharing; meaningful performance measures that can be derived from practice; patient engagement tools to support behavior change and alignment of payment reforms across payers and other providers.
ASCO’s Consolidated Payments for Oncology Care (CPOC): Jeff Ward, MD (Past Chair of ASCO’s CPC and Payment Reform Taskforce): Dr. Ward discussed the goals of CPOC: a payment structure that is patient centered and better matches services that patients need; simpler billing structure; more predictable revenue; incentivizing high quality care; and coordinated, patient-centered care. Monthly payments – “mini-bundles” – are based on phases of care: new patient, treatment month, monitoring month and transition of treatment. Additional payment adjustments are based on ASCO’s Quality Oncology Practice Initiative (QOPI) with quality measures phased in over time: pathways in two stages: adherence and use of certified pathways; resource utilization, and clinical trials with higher treatment month and non-treatment month payments for enrolled patients. The expected impact of all of this is more flexibility for practices, more accountability for quality care and costs, and simplification.
Medicare’s CMMI Oncology Specific Alternative Payment Proposal: Ron Kline, MD and Heidi Schumacher, MD (Medical Officers, CMS-CMMI): Dr. Kline reviewed the CMS Centers for Medicare and Medicaid Services (CMMI)’s priorities of exploring new payment and service delivery models engaging a broad range of stakeholders. The bottom line is better treatments and lower costs. They are in the testing phase with specialty practitioner focused models. Oncology is among the first focused models because of its importance to patients and cost to the system. He said that new designs must strive for the “Triple Aim” of improving the patient care experience, improving the health of populations and reducing the cost of healthcare. Dr. Kline provided an overview of the Oncology Care Model (OCM), a “Total Cost of Care” model that includes episode-based treatment and requires practice transformation to improve the quality of care.
Private Payer Initiatives to Change Payment: Jen Malin, MD (Medical Director WellPoint–Anthem): Dr. Malin talked about Anthem’s quality care initiative that involves additional reimbursement for treatment planning and care coordination. The program identifies specific cancer treatment pathways based on medical evidence, peer-reviewed literature, consensus guidelines and Anthem’s clinical policies with the goal of supporting oncologists in choosing the most effective cancer therapies that provide the most value possible.
Questions discussed at the end of the webinar related to more specifics concerning “pathways,” site for service, and the total cost of care model. A common concern from the webinar viewers was, “Can we really believe that FFS will be transformed to alternative payment models? How real is this?” Dr. Patel answered by saying that what is real is everyone’s frustrations with FFS. What’s questionable is how to move off of it and how fast we can move off of it. She goes on to say that the industry is using a “building blocks” approach with some of the new payment models still using FFS; the trend, though, is to move away from it.
Transitioning to new payment models may be a large undertaking and investment. But the idea is no longer just theoretical. With the guidance available from neutral, physician-led, transparent bodies like ASCO supporting this trend, the new voluntary CMMI program and the many innovations in the works between oncology practices and payers, it is clear that momentum is building toward value based payment models.