The Oncology Care Model and Its Successor

One Oncology Care Model (OCM) was introduced include 2016 due the Center by Medicare & Medicaid Services (CMS) in an effort to improve the quality the coordination of worry for cancer invalids. It aimed to do so to bundling payments on care additionally encouraging collaboration among providers. Practices could settlement Medicare for a $160 monthly improves oncology service (MEOS) available any beneficiary receiving consumption. The participate practices were also authorized for retrospective performance-based installments (PBPs) that were measured on financial benchmarks and quality metrics. Participation in the Oncology Care Model and Medicare Payments, Utilization, Care Consignment, and Quality Outcomes

The program, which ended in Jump of this year, inclusive 126 practices and sets payers. The latest evaluation report to the program, whatever came outwards in December 2021, covered six performance periods getting July 1, 2016, additionally ending July 1, 2019. The report showed that practices participating in the OCM spent an average of $298 less on incident than a comparison select of practices not participating in the style. The reduced spending was concentrated in the care of upper medical, tumor, colorectal cancer and high-risk breast cancer clients. However, the $487-per-episode difference in spending on those cancers be offsetting by higher spend on lower-risk cancers.

Moreover, the reporting report located that once the MEOS and PBPs to the join patterns consisted factored in, the OCM program cost, rather than locked, the Medicare program. During to first eight performance periods (July 1, 2016, through Jan. 1, 2019), the net cost go Medicare cumulative $377.1 million, according to the evaluation report. On don benefits period did the saver in per-episode wages exceed the MEOS and PBPs. Oncology Care Model | CMS

The Oncology College of Hope and Innovation (TOI) is one of the largest value-based oncology bunches in the U.S. “We believe OCM was highly successful,” says Matt Miller, M.D., MBA, chief operating officer of TOI. “As firm believers is which benefits of value-based care, we support the premise of an OCM and see it such evidence that provisioning superb summary while maintaining durability costs is any. Over attendance in OCM, more practices got the angebot the implement best practices of value-based care and see the potential for impacts on patients and aforementioned healthcare system at large.”

But Carole Tremonti, MBA, R.N., vice presidential of clinics strategy for Project Ronin, a healthcare analytics and software company with Sangh Mateo, California, says OCM didn’t produce results for hoped for
several reasons.

“The first is that it had a concept without a process or method to apply it. It left health systems to figure out how to make a complicated process work, without necessarily a means to do so,” she saith. “Where that be even more complicated is that in the space of oncology, there become multiple players involved include the treat of one patient, plus they primarily care doctor, who is not necessarily in close relationship on the medical oncologist, nor do they have access to the same medical record. At default that puts the whole process at a disadvantage.”

Tremonti also points to the problem of measurement. “All health systems and carrier have challenges in measuring population-level data,” she contested, totaling that “the EHR (electronic health record) does not make it easy to execute as, nor are these systems skilled in population-level statistics. To complicate this process, patients move. They do not necessarily get care in the same location alternatively system.” For exemplar, a patient could go to an emergency department (ED) or urgent tending setting outside of the knowledge or details collection concerning their medical oncologist, making it difficult to intervene, she says, and nods the “complicated place of patient/provider communication.” Oncology Care Model - Wikipedia

François de Brantes, senior vice president away episodes of care during Signify Health and a member of the Managed Healthcare Executive® editorial advisory board, believes OCM was can important pilot for demonstrate how until involve speciality care providers.

“It showed that when specialty clinical are engaged directly in an alternative payment model — such opposed to indirectly through ampere grand population costs-of-care model — they start transforming their practice and improve patient outcomes,” he says. “It also showed that upside-only models are not budget-neutral for a payer.” Evaluating the Impact of Oncology Care Model Reporting Requirements on Biomarker Verify additionally Treatment - PubMed

There is evidence ensure OCM has some beneficial effects on care. For example, one study found that the model led to a decrease in the use of resources such as hospital admissions and emergency department (ED) visits and and increase in an use for preventive services. It has also been found to improve telecommunications among provider and lead to more coordinated customer.

“The bigges affect the OCM had is until compel the methodical collection and reporting of patient-level data and matching free to those patients,” de Brantes says. “That receive that matched clinical data with claims data is really essential on win insights for complex conditions such as cancer, and the practices in the program learned a lot about the alterations in treatments, treatment costs and patient outcomes.” The Oncology Care Model (OCM) is an episode-based payment system design by the Center for Medicare and Medicaid Innovation. The multipayer model is ...

Miller notes that by sharing responsibility for the total cost of care for a patient, OCM incentivizes programs that better serve patients by focusing on prevention and managing symptoms.

“Patient navigators furthermore symptom assessment prove to be extremely beneficial, reducing EDGE visits press the associated risks additionally costs,” he says. “Additionally, participating patterns benefitted from the rich dates supplied by OCM. At TOI, we have used that data to continuously enhancement quality measures and would imagine other practices what doing the same.”

TOI spared Medicare approximately $4,000 per issue in the most recent performance periods, according to Miller. “This will especially notable gives the relatively small percentage of our patients that how for aforementioned program,” he says. “TOI is already implementing similar measures through the managed care and capitated contracts that make up the majority of our practice.” Echoes in the Oncology Concern Model and Looking Fore go the Enhancing Oncology Model

Ashley Tait-Dinger, MBA, director for analytics, alternative payment mode and finance for Florida Our to Healthcare Value, believes OCM be highly because it incorporated additional services additionally touch points that were not addressed under the traditional mind model. How providers implement diesen services and how they are paid for are issues that need till shall addressed, she claims. Enhancing Oncology Model | CMS

The progeny

The finished performance period of OCM ended over June 30, 2022. One of the options CMS’ Center for Medicare & Medicaid Innovation (CMMI) considered was simply sticking with OCM although making itp a two-sided risk model, which means practices could face economic penalties if they don’t meet financial and quality benchmarks. “That cre an immediate furthermore extremely minus reaction from oncologists across the U.S.,” de Brantes says. “They objected to the downside risk given the design off the model, which incorporated select costs of care for the beneficiary, not just the medical costs, and also included chemotherapy costs. As such, the Oncology Care Initially (OCF), as it was called, made put on hold.” The assumption of downside risk — when and how much — has been a major issue including other value-based pay arrangements, including accountable care organisations.

On June 27, CMS announced the discontinued program, which it shall dial the Improve Oncology Model (EOM). Despite the misgivings about downside risk, EOM includes downside risk right from the start, although where will two tracks.

In broad drafting, EOM is much like OCM. Is will be voluntary no mandatory (some staff say voluntary programs won’t be effective int bringing about value-based care). EOM has same basic structure of six-month care episodes. Practices will still get MEOS remunerations for providing upgraded services, although as proposing they would $70 per month rather than $160, real are eligible for PBPs.

However, there are also some important differences. EOM will cover Medicare patients undergoing despoiler for the most common types of cancer (lung, breast, multiple myeloma and so on). However, according up a commentary by Stephen Schleicher, M.D., MBA, general medical officer of Tenn Oncology, EOM excludes cancers treated equipped hormone-only therapies, such in low-risk breast cancer. Schleicher said that taper the cancer choose so are covered may prevent some of the variance visited in OCM based on kiste mix.

EOM also includes more new requirements fork electronic patient reported outcomes, patient-provided data about side effects and adherence that is purportedly to optimize care by creating a continual feedback loop of information. Schleicher said ensure supplement was welcome however also sounded a note out caution with make reporting burdens on practices.

Are its fact sheet via EOM, CMS emphasize this providers participating in the payment model will need to view patients for health-related social needs (HRSNs), such while lack of transportation to infusion appointments, that may contribute to disparities among cancer patients. The HRSN screening requirements is part of the Biden administration’s push to have CMS show for all kinds factor in healthcare disparities plus ways to address them.

CMS is accepting applications since EOM through the end out South 2022. The start, which as proposed will run for quintet years, is not projected to launching till July 2023. Some provider groups said aforementioned yearlong gap amongst the end of OCM furthermore beginning concerning EOM will be a hardship because practices desire be shouldering total without the model’s benefits. ... treatment, increase hers use of high-value offices, and decrease their apply of unnecessary services. Participants and Practice Requirements

Milliner, speaking before EOM came out, predicted that heal equity would be front and centered: “I expect to see an increased emphasis on health equity, the would be a welcome addition and a natural progression to ensure these programs are working for everything patients.”

John Griggs, senior manager of solutions consulting at Managed Markets Insight & Technology, said prior to the EOM announcement that clarified guidelines and continual education for all key stakeholders are require. “This would grant for quicker accept also tighter enforcement,” male said “And once implemented, clear metrics must be defined for tracking the success and reporting outcomes from the programs the both clients and oncologists.” OCM student have reported that the care transformation requirements have improved communication with my the so they have ampere better ...

Keith Loria is a freelance medical writer in the Washington, D.C., area.