COA: Community Oncology Alliance

Providers should be involved in new reimbursement model development from day 1, said Roger Brito, DO, national director for oncology, Aetna.

When a drug becomes first-line, I would like to think that as a clinician I would have access to that, but most importantly that my patients would not have to have a bake sale or take out a second mortgage on their homes to get therapies that are designed specifically for them, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Bo Gamble, director of Strategic Practice Initiatives at the Community Oncology Alliance (COA), explains how COA plays a role in supporting practices in preparing for Oncology Care Model.

Over the next years, these spheres (ACOs, primary care, and oncology) that are going on in CMMI need to be coalesced together so that when we have learning collaboratives, not only do we have learning collaboratives within each of these spheres, but we learn from each other in these similar projects, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Aetna is focusing on the healthcare triangle (patients, providers, and payers) and connecting those lines, said Roger Brito, DO, national director for oncology, Aetna.

In order to adapt to the Oncology Care Model (OCM), Regional Cancer Care Associates had to undergo the process of adjusting and customizing its electronic medical records, explained CEO Terrill Jordan.

We should try to remove barriers that are not only in place, but getting higher for clinicians and patients to get evidence-based care, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

The ability to have a plan that’s going to work and be large enough that it makes sense for those involved is a barrier for employers who want to pursue alternative payment models, said David Merrill, HR benefits manager, Volusia County, Florida, and John Robinson, CEBS, REBC, RHU, president and CEO, RobinsonBush.

It’s very unusual to see significant cost savings in the first year of a program; that was true of all the pioneer ACO programs, said Jeff Patton, MD, CEO of Tennessee Oncology.

Involving providers in the development process of new reimbursement models increases the chance that the initiative will be successful and works against caregiver burnout, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Don’t underestimate the power that it takes to make sure a value-based program is working, said Sarah Cevallos, chief revenue cycle officer, Florida Cancer Specialists.

The healthcare triangle (patients, payers, and providers) begins with the patient, so we should include the patient in some of the decision-making, said Roger Brito, DO, national director for oncology, Aetna.

The fact that you have certain drugs that treat numerous cancers, and that they may treat 1 cancer different or better than another, would suggest that we should probably have differential pricing models, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Bo Gamble, director of Strategic Practice Initiatives at the Community Oncology Alliance (COA), believes that broadening communication and education is COA’s main goal in 2018.

Southwest Airlines has set up a split fill program, pharmacy benefit manager, health advocacy program, and a cancer resource guide for employees, said Judy Berger, senior manager, benefits planning, Southwest Airlines.

Year 2 of the Oncology Care Model is about learning from the lessons of year 1 and extending implementation that has already been started, said Terrill Jordan, CEO of Regional Cancer Care Associates.

Until more data is available, it’s difficult for a practice or physician group to make an accurate assessment of whether or not 2-sided risk is appropriate, said Sarah Cevallos, chief revenue cycle officer, Florida Cancer Specialists. Physicians would need to see clear metrics in order to know if they will be achievable.

Based on CMMI's year 1 feedback on OCM, it is clear that a lot of planning is needed and education is crucial, said Terrill Jordan, CEO, of Regional Cancer Care Associates.

As people get more empowered and more informed with data, such as their own electronic medical records, they will utilize the information to do better for themselves and improve their health, said Lucio Gordan, MD, of Florida Cancer Specialists.

Pharmaceutical companies would like to see value-based contracts that are multi-year and over large populations, said Ira Klein, MD, MBA, FACP, senior director of healthcare quality strategy for the Strategic Customer Group at Janssen Pharmaceuticals.

The healthcare industry is getting better at creating value-based drug pricing arrangements, and even if they never dominate the market, there will always be a place for these contracts, said Ira Klein, MD, MBA, FACP, senior director of healthcare quality strategy for the Strategic Customer Group at Janssen Pharmaceuticals.

Tuple Health, a healthcare technology startup, interviewed some of the stakeholders participating in value-based care delivery and OCM, to gain their perspective of the state of cancer care and healthcare reform. The results were presented at the Community Oncology Alliance Payer Exchange Summit on Oncology Payment Reform.

Representatives from 3 payers who partnered with providers on the Oncology Care Model (OCM) took the stage at Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform to outline their experience with OCM and how it has differed from other care models.

Education is key to succeed in the Oncology Care Model, but presenting data in a simple format for clinicians to use is also critical, said Terrill Jordan, CEO, of Regional Cancer Care Associates.

Before physicians will be more willing to take on 2-sided risk, there needs to be clearer metrics that the physicians know will be achievable, said Sarah Cevallos, chief revenue cycle officer at Florida Cancer Specialists.

Implementing OCM has presented several challenges, such as manually submitting data, keeping up with status of therapy, and billing, said Jeff Patton, MD, CEO of Tennessee Oncology.

The implementation of the Oncology Care Model has brought profound culture changes to how oncologists take care of patients and how they operate practices, explained Lucio Gordan, MD, of Florida Cancer Specialists.

With the Oncology Care Model now in its second year, 3 representatives discussed learnings and how the program can change, as well as incentivizing physicians to accept 2-sided risk, the ability to engage additional payers, and the future of oncology bundle payments.

Participants from 2 oncology community practices—an oncologist–administrator combination—shared their experience with implementing the Oncology Care Model (OCM) with attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

The Community Oncology Alliance (COA) is forging ahead with its COA Patient Advocacy Network (CPAN), says Rose Gerber, director of patient advocacy for COA. The network’s major focuses include increasing its presence and making it easier for community practices to get involved.