Mike Fazio Breaks Down the Decision to Take on Downside Risk in OCM

More practices than expected seem to be interested in staying in the Oncology Care Model (OCM) and taking on downside risk, said Mike Fazio, senior vice president of client services, Archway Health.

As practices in the Oncology Care Model have to start deciding if they will move to downside risk, what are you seeing about that decision?
It is interesting. We see about a third of our customers that have seen strong performance in OCM look and get interested in what downside risk in OCM means and it is for them. So, we’ve been helping them make that decision using their data since about the spring. There’s another third that maybe are borderline earning a savings in OCM and haven’t or just made it over the line, and they might have to take downside risk—it might not be a choice. If you haven’t earned savings: It’s a decision to either leave the program or pursue that arrangement. So, they’ve been having conversations, around the same time in the spring, what downside means for them and how we can model that. And we do that internally.

And then there are those who haven’t been performing well at all. And I was surprised, I thought that group—so again, about a third of our customer base in OCM—I didn’t think would even consider downside risk. But they’ve expressed that “We don’t want to leave the model.” MEOS [Monthly Enhanced Oncology Service] payments have been a great way for them to hire navigators and experiment with care coordination efforts. And they’re not ready to leave the model during this last year, which is performance period 8, which starts in January of 2020. So, they’ve come to us and asked about risk protection. So, I’ve been surprised at that.

So, I guess overall, more interest in downside than we expected, and we do provide guidance on what that is, and we even offer a stop-loss product to protect against that risk. So, it’s been an interesting journey, recently.
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