Dr Lalan Wilfong Provides an Overview of Key Learnings From the OCM
Looking at total cost of care is difficult and figuring out what the practice is responsible for and not responsible for can be very difficult to do, said Lalan Wilfong, MD, executive vice president of Quality Programs at Texas Oncology.
What are some key learnings in the OCM and how can they be applied to other reform models?
There have been a lot of key learnings from the OCM and how it would relate to other payment models. One is that attribution is key and making that an easy process for the practices. They have to know that the patients they enroll in the model are in the model and have that collaboration with the payer to make sure that the attribution is done well and done quickly for the practice.
Looking at total cost of care is difficult and figuring out what the practice is responsible for and not responsible for can be very difficult to do. Case mix is a huge issue as well– for breast cancer for example, there can be quite a lot of variation in the appropriate price of care for different patient populations.
Especially for small practices with small populations, just a little bit of a case mix difference can cause huge variations in the total cost of care. But, I think the big key learning is that whatever payment model you’re in requires significant collaboration between the practice and the payer. A lot of trust has to go into that relationship– trust that the payer will give you information timely, trust that the practice will do what they say they will do, and really look at improving value that they provide the patients.