New oncology payment model accelerates shift to value

May 24, 2016

Participants in a new CMS payment program will attempt to improve the effectiveness and efficiency of cancer care delivery. Here’s how.

Participants in a new CMS payment program, the Oncology Care Model (OCM) will attempt to improve the effectiveness and efficiency of cancer care delivery by aligning financial incentives and accountability for episodes of care involving chemotherapy.

The Center for Medicare and Medicaid Innovation (CMMI) presented a request for application (RFA) for the alternative payment demonstration model in February 2015. Applications were accepted the end of June 2015 with subsequent invitations to participate extended at the end of March 2016 to chosen practices. The program will begin July 1, 2016.

Hartung

“The CMMI OCM project has three overarching goals: better care, smarter spending, and healthier people,” according to Nicole Hartung, MD, medical director of quality for Minnesota Oncology, a practice in The US Oncology Network. “They plan to achieve this by providing a monthly per-beneficiary-per-month payment to offset the costs of needed infrastructure development to provide the required components of the project.”

These required components include:

·      Enhanced 24/7 access to care;

·      Patient navigation and care coordination to manage potential gaps in care;

·      Patient treatment plans in accordance with the Institute of Medicine recommendations;

·      Survivorship care plans;

·      Greater end of life discussions including specific goals of therapy and advance care planning amongst others.

There is a subsequent shared savings payment to incentivize practices to lower total cost of care via performance-based metrics.

Cancer care will continue to focus on the development of more effective, less-toxic treatments; however will also incorporate a strong focus on payment redesign while implementing the methodical, equitable provision of the delivery of comprehensive cancer care, according to Hartung.

Next: Cancer care crisis

 

 

The 2013 Institute of Medicine report “Delivery High Quality Cancer Care-Charting a New Course for a System in Crisis” describes the current state of cancer care in the United States as one in crisis due to a “growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs.”

“There is also variation in care depending on site of care, physician preference of treatment and geographic region,” Hartung says. “Opportunities exist for improved supportive care and side effect management during treatment and ability to assess and address psychosocial needs during and after treatment. In our current landscape of escalating healthcare costs as a high percent of gross national product, it is no longer feasible to not address these issues.”

Since October 2015, The US Oncology Network, an organization made up of oncology practices dedicated to advancing high-quality, evidence-based cancer care,has worked with McKesson Specialty Health to prepare for the start date of the OCM by developing a “how to playbook,” according to Hartung.

“This workbook comprehensively addresses all aspect of both the required components and performance-based improvement metrics of the OCM,” she says.

This was created through the development of five distinct work streams with assigned tasks to create the tools and work flows needed to meet the requirements of the OCM: 

  • Care and support, including defining work flows, processes and tools

  • Technology requirements

  • Care paths

  • Communication, compensation and revenue cycle management

  • Mobilization (preparation for the OCM start date)

The output from the work streams was incrementally implemented at three of The US Oncology Network affiliated practices in Loudon, Virginia; Boulder, Colorado; and Waco, Texas starting March 1, 2016 to test the new care blueprints and make changes as needed. As each site became adept at the care delivery models, they have expanded the activities to other offices within their practices, according to Hartung.

“We have learned how to more flexibly implement change and engage all the necessary stakeholders-physicians, APPs, nurses, MAs, administration and executives-on this enhanced model of care,” she says.

The result of the work done to date from the planning and subsequently pilots culminated in a “boot camp” in early May 2016, according to Hartung. Quality leads (physician, nursing and administrative) from all practices invited to participate in the OCM were brought together to learn specifics of the care delivery blueprints and business modifications that will be needed.

“This allowed all practices to have a realistic understanding of the transformation that will be required to succeed in the OCM,” Hartung says. “We believe that by transitioning to this model of care, one that is patient-centered and heavily designed on a schematic of team-based care, that our delivery of healthcare will be more consistent with less gaps; better incorporate the patient’s perspectives and values in treatment decisions and will decrease total cost of care