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Nine Months in: Understanding the Oncology Care Model
May 12, 2017

Nine Months in: Understanding the Oncology Care Model

As we near the first anniversary of the Oncology Care Model, CMS’ bundled payment program for oncology, explore why practices are participating and the challenges they have faced over the past 9 months. 
Challenges
Of course, OCM is not without challenges. Success in any APM requires significant investment from providers. Furthermore, OCM is a pilot, meaning that CMMI and OCM participants will learn together as the program progresses—understanding which policies work and which don’t, and implementing course corrections as necessary. 
 
Target Price Methodology. An effective target price methodology generates a target that holds providers accountable for the things they can impact, and is adequately risk-adjusted for factors beyond their control. While other Medicare bundled payment programs typically generate a target by calculating the average historical performance and adjusting for 1 or 2 factors, such as a fracture in MJR or a hospital admission with major complications in coronary artery bypass graft procedures, OCM uses a regression model (technically, a generalized linear model with a log link and gamma distribution) to risk adjust for numerous factors.

While the CJR methodology results in 4 possible target prices, the OCM methodology results in thousands of possible target prices. There is not a single target price for a breast cancer patient; there is a target price for an 80-year-old, dual-eligible females with 4 comorbidities, receiving adjuvant chemotherapy for breast cancer in a clinical trial. If one of those factors is changed, the target price is changed. This level of complexity is necessary to match the complexity of the disease. However, the current OCM target price methodology still lacks adequate risk adjustment. CMMI is limited to only using factors that can be found in claims data, which excludes key information such as stage. CMMI is collecting certain clinical data from the OCM participants in part to improve the methodology, but these key clinical factors are unlikely to be incorporated prior to PP4.
 
Data Reporting. While practices should and do want clinical measures incorporated into the target price methodology, operationalizing the collection and reporting of these measures can be challenging. Practices are also required to report on certain quality measures in order to assess their eligibility to receive PBP. Practices are attempting to leverage their electronic medical records and tumor registry reporting processes to meet the OCM reporting requirements. Weller-Ferris admits that the associated information technology build initially demanded significant internal resources. In response to OCM stakeholder concerns, CMMI revised reporting timelines and is working to better streamline the reporting process.
 
What’s Next?
Practices will spend the next few months attempting to analyze their claims data to identify targeted care interventions, preparing for the next major data reporting deadline in September and executing all associated work flow changes. In future blog posts, we will delve deeper into individual OCM policies and chronicle practice implementation efforts. A follow-up case study will be forthcoming as well: stay tuned!

 


 
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