Stakeholders Weigh-in on Payment Reform in Cancer Care

Surabhi Dangi-Garimella, PhD

When the Oncology Care Model (OCM) program was announced by CMS in early 2016, 196 practices and 17 payers signed on to participate in the 5-year program—per the CMS website, the numbers now stand at 192 and 14, respectively. 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 Basit Chaudhry, MD, PhD, co-founder and CEO of Tuple Health, and Celeste Roschuni, PhD, user researcher, Tuple Health, at the Community Oncology Alliance (COA) Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

“Our focus, with these interviews, was on practice variability, stakeholder perception of value/risk, and the transformation process, Roschuni said.

Considerations for practice variation included factors such as the practice size and scope, geography, patient population, all of which influence structural capacity of a practice, according to Roschuni. The biggest influencer, they found, was a practice’s previous experience in delivering value-based care.

Roschuni pointed out that prior experience is more important than practice size. “The general sense is that the OCM design is meant for larger, more advanced practices. But each practice has its own struggles, and there’s really no average OCM practice” she emphasized.
Tuple Health categorized the surveyed OCM-participating practices into 4 main types, with their qualitative performance predicted based on their experiences. Perceptions of Value and Risk
The survey found a wide variation in value perceptions. The survey found surprising similarity in stakeholder perception of risk. “Risk is compounded by cost inflation within the pharmaceutical industry,” Roschuni explained. An example of this is that practices are holding their oncologists responsible for the total cost of patient care, which includes drug costs.

“Another risk is of adverse patient selection because payers have not yet developed robust risk-adjustment methods for their payment models,” Roschuni added.

Speaking to stakeholder transformation to adapt to the world of value-based care, Roschuni highlighted the fact that it requires a spectrum of activities—it is not a single event. A major learning from the survey was the importance of physician buy-in—a fact that was reiterated by several participants at this year’s meeting.

“Extending a practice’s influence requires network development and an expanded scope of the practice’s service,” Roschuni said, adding that practices often find it easier to expand their network and develop partnerships with other healthcare delivery clinics. However, neither expanded scope of service nor network expansion are accounted for under the current iteration of OCM, Roschuni concluded.
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