This article has been co-authored by Alyssa Dahl, Principal Healthcare Informatics Analyst, DataGen.
The Oncology Care Model (OCM) is a 5-year alternative payment model (APM) for oncology practices and independent practitioners that began on July 1, 2016. Participants, whose episode cycles run for 6 months, will receive their first performance data feed from the CMS by the end of March.
When the program began last year, we helped our clients visualize their baseline data in order to analyze, identify, and build out their strategies. However, participants should be ready to reassess and modify their approaches after this first data feed.
Shifting viewpoints and reassessing strategies
The perspective that participants had in the first 6 months of OCM is going to shift with this new information. Whereas the baseline data were entirely retrospective, thes performance data will reflect that participants were in the process of deploying OCM practice transformation requirements across the course of the episodes. We expect this first data feed will allow participants to make more connections with the data and will help them understand their information differently.
Because of this, participants may need to reassess their strategies. One thing we anticipate is a push towards aligning with nationally recognized care patterns and care plans for specific types of patients, especially around non-chemotherapy drugs—for example, drugs to support bone density or immune health. Approaching OCM as a reimbursement model beyond chemotherapy is something we’re already looking at with our clients, and will likely continue to expand on as the program evolves.
The first data feed is going to be much more incomplete than participants expect, because not all episodes initiated during the past 6 months have concluded, and because it’s difficult to anticipate what will happen during an episode. When an episode starts in OCM, it’s nearly impossible to have a clear target in mind—while there may be anticipated static factors, some factors in the target-setting may change due to circumstances that arise during the episode. A lot can change during a 6-month period for a cancer patient.
Risk adjustment under OCM is also incredibly complex and is influenced by several factors, including:
Type of cancer
Prior chemotherapy treatment
Need for surgery
The long list of risk adjustments compounds the difficultly of assessing the target until after the episode is over.
As this program moves forward, there is growing realization withint CMS on things they didn’t consider when they first set the targets. In February, CMS announced they will recut the baseline data after recognizing additional factors that should have been considered in the target-setting for bladder and prostate cancer episodes. We are likely to see other things like this as we continue to learn more about these episodes.
First, we hope participants will look at this data feed with fresh eyes and without preconceived notions of what statistics are the most important. Participants will get the most out of the data feed if they are curious and open-minded. Second, participants shouldn’t try to compare performance to a target just yet, since most of the 6-month episodes were not complete when the data was cut. Participants will need to set expectations with leadership so they understand that it’s too early to evaluate how well their practice is doing in the program. Finally, we hope participants will be patient and avoid getting frustrated by the fact that they cannot evaluate success from this first data feed. Instead, we recommend taking the approach that this program is a learning experience—one that will better prepare the practice for future CMS programs and value-based reimbursement.