Study: Success in Value-Based Oncology Model Depends on This Key Factor

Kane

The ability of an oncology practice to succeed in the Oncology Care Model (OCM) can vary depending on the types of cancers treated by the practice, according to new research.

The OCM, the Center for Medicare & Medicaid Innovation (CMMI) program, is a voluntary five-year bundled program designed to provide higher-quality, better coordinated cancer care at the same or lower cost to Medicare beneficiaries.

The research, from Avalere, examined the costs of care and the implications for OCM performance-based payments for each of the 21 OCM cancer types. The findings were presented at the American Society of Clinical Oncology Quality Care Symposium September 28-29, 2018, in Phoenix.

Related: How the Oncology Care Model is Changing the Trajectory of Cancer Care

“For some types of cancers, such as lung and liver cancers, it will be more difficult for clinicians to keep treatments costs below OCM target prices or to achieve high-quality scores, thus making it difficult for them to earn performance-based payments,” says Richard Kane, senior director in Avalere’s policy practice.

There is broad interest in understanding the effect of the OCM’s financial incentives because the OCM is an alternative payment model (APM) that affects one in five cancer patients in traditional Medicare fee-for-service and it is the only Medicare APM that focuses on specialty care and that includes Part B and Part D drugs, according to Kane.

“Healthcare executives want to understand how the OCM payment model works, including how it may measure performance when treating certain populations or when using specific treatments,” he says.

Avalere’s research also found that quality scores in the OCM varied by cancer type.

The cancer types with lower-quality scores were often the same as those for which treatment costs were higher than predicted, “again reinforcing that clinicians will have a more difficult time earning performance-based payments when treating certain cancer types,” according to Kane.

Because of OCM program requirements, patients treated by an OCM-participating provider likely will have more access to medical experts and may experience more evaluations and/or monitoring, according to Kane.

“Oncology practices are undergoing transformational change in order to meet OCM program requirements, which while burdensome for most practices may also position them for future value-based programs,” he says.

According to Kane, healthcare executives can be successful in the OCM by:

• Carefully monitoring patients through an episode of care
• Looking for ways to control costs (e.g., hospitalizations)
• Tracking performance on quality metrics