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December 26, 2017

Will 2-Sided Risk Be a Reality in OCM?

Kelly Davio
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.
The Oncology Care Model (OCM), a pilot reimbursement program developed by CMS’ Center for Medicare & Medicaid Innovation (CMMI), is now in its second year. To discuss the learnings and how the program can change, 3 provider representatives from across the country sat on a panel with representatives from CMMI at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia. The discussion touched on incentivizing physicians to accept 2-sided risk, the ability to engage additional payers, and the future of oncology bundle payments.

Moderated by Lara Strawbridge of CMS, participants included Andy York, PharmD, JD, CMS; Terrill Jordan, Regional Cancer Care Associates (RCCA); Jeff Hunnicutt, Northwest Medical Specialties; and Ahmad Mattour, MD, Henry Ford Health System.

York started the discussion with a presentation on lessons learned in the cancer episode-of-care space. He then provided an overview of the OCM, describing it as a 2-part model designed around episodes of care, with emphasis on:
  • 24-hour access to care
  • Care navigation
  • Treating patients with treatments aligned with national guidelines
OCM wants physicians to use certified electronic health records (EHRs), and use their data for care quality improvement. OCM reviews 6-month episodes of care, and allows performance-based payment based on retrospective performance. It’s a multi-payer model with 17 commercial payers participating, York told the audience, adding, “We need more participation to reach that critical mass of payers.”

Past, present, and future of OCM
While 196 practices initially participated in OCM, the number is now at 192 following practice consolidations, York said. He highlighted the following major milestones so far:
  • Three quarterly feedback reports with claims data have been shared with enrolled practices
  • Practices currently have 2 submission periods
    • First round of clinical data submission has occurred
    • On schedule to provide the first round of reconciliation in early 2018
York mentioned that the short-term changes that CMS is working toward is to reduce the reporting burden by working with EHR vendors and stakeholders. Acknowledging that “it’s been a moving target,” he said that one change has been to move from quarterly to semiannual reporting. The more long-term goals are to refine the OCM bundle by being responsive to program participants.

York recommended a continued dialogue between payers—both commercial and CMS—and providers as the model continues to be refined. “For many payer partners, having large enough bundles is a barrier. But it’s okay to start with higher-volume, more predictable cancer types,” he added. Importantly, all changes to the program should be scalable and sharing best-practices is a very good way to move forward and improve, he said.

Speaking to the experience at RCCA, Jordan said that they started looking at clinical integration, a holistic model of providing care, not just in office but working with physicians in other offices, prior to OCM. It made sense for them to “work on a roadmap we didn’t have to build ourselves.” Being able to work with other like-minded practices was important, according to Jordan.

For the Henry Ford Cancer Center, joining the OCM program “was the right thing to do,” said Mattour, adding that the change would provide the means to implement the quality projects they wanted to deliver to patients and achieve a higher level of care. He noted that their previous experience with similar models, such as a CMS project focused on evaluating earlier screening for cancers in specific populations, would provide benefits in terms of cost reduction.

Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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