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Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Proposed as an alternative to CMS’ Oncology Care Model, the Community Oncology Alliance is developing its Oncology Care Model 2.0 with the hopes of creating a better, more efficient payment and treatment system for cancer care.
Preparation is underway for a new payment model for cancer care, and the model’s developers are hopeful that it will offer the simplicity and cost-savings that they say other models lack.
The Community Oncology Alliance developed the Oncology Care Model 2.0 (OCM) as an alternative to the CMS’ OCM. It’s a payment reform model that tests flexible, universal payment reform templates, recognizes and rewards high-quality and high-value cancer care, promotes reporting simplicity and transparency, and addresses the price of cancer drugs though value-based initiatives. According to the plan’s design, the OCM 2.0 emphasizes value-based clinical decision making with a goal of improving patient outcomes while reducing costs. Bo Gamble, director of strategic practice initiatives for the Community Oncology Alliance says the OCM 2.0 stresses the need for better payment practices when it comes to cancer care.
The model will be tested through June 2021 in 176 practices covering more than 150,000 Medicare beneficiaries.
According to the plan’s design, the OCM 2.0 emphasizes value-based clinical decision making with a goal of improving patient outcomes while reducing costs.
Bo Gamble, director of strategic practice initiatives for the Community Oncology Alliance, says the OCM 2.0 stresses the need for better payment practices when it comes to cancer care.
“This OCM 2.0 model emphasizes the changes that need to be made for universal oncology payment reform and with all payers, including federal, regional, local and employers,” says Gamble. “There are three specific areas of focus-the care delivery, the measures of the quality and value of the care delivered and meaningful payment methodology that rewards outstanding quality and value.”
The goal of the Oncology Care Model 2.0 is to define and implement standards for providing excellent cancer care using a uniform set of measures that would prove-or disprove-whether excellent care was provided, says Gamble.
It also includes a transparent, adaptable payment methodology for rewarding expertise in cancer care.
“The expected outcomes are an improved experience for patients with cancer, and overall savings to our healthcare system,” says Gamble. “The Oncology Care Model 2.0 is expected to bend the cost curve for cancer care and reduce spending. This is a two-prong approach; emphasis in the total cost of care and incentives designed specifically for treatments so that value that lowers the cost of treatment, is stressed. Lessons learned in these pilots could be implemented more globally.”
The two biggest challenges when it comes to reimbursement are communications and transparency. In terms of transparency, Gamble explains that it can be difficult to compare similar cases in cancer care.
“Each cancer patient is unique, which calls for the expertise and guidance of the oncologist,” he says. “However, the goal of most oncology models is to compare like cases. The logic and algorithms to do this is complicated which reduce the ability of the care team to understand the logic. This is a challenge because the care team needs a working knowledge of these processes so that areas for improvement can be identified and addressed. Similar challenges exist for attribution and patient inclusion in a model. The OCM 2.0 seeks to improve the transparency of all reform models.”
In addressing the issue of communication problems, Gamble says there needs to be more clarity, with timely and appropriate follow-up.
“Past and present reform efforts have suffered from communications issues that impact the ability of the care team to react and address things that are identified. Sometimes teams are told six-plus months after the fact about issues that give them little opportunity to address them. The Oncology Care Model 2.0 addresses communications issues we see in reform efforts, particularly with timeliness and clarity of communications.”
The OCM 2.0 is still in the review process and stakeholder responses are currently being received and evaluated, says Gamble.
“We hope for the Oncology Care Model 2.0 to start a dialogue with all of those involved in the cancer care journey, from patients, to care teams, to payers, to employers and beyond. The Community Oncology Alliance has an ambitious vision for how we can improve cancer care and need support and input to make it a success,” says Gamble. “This is particularly true of employers who are responsible for more and more of the costs of cancer care. Ultimately, the path to universal oncology payment reform will be a long journey, so patience, perseverance, and collaboration will be needed.”
Rachael Zimlich, RN, is a writer in Columbia Station, Ohio.