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5 Significant OCM Questions Addressed During the COA Payer Summit


At the Community Oncology Alliance's Payer Exchange Summit VII: Oncology Payment Reform, practices shared their challenges and successes in the second year participating in the Oncology Care Model.

The Oncology Care Model (OCM) is a 5-year pilot that was floated in 2016 by CMS’ Centers for Medicare & Medicaid Innovation (CMMI). An episode-based care model, OCM incentivizes high-quality, coordinated care to improve outcomes of patients receiving chemotherapy for their cancer. Currently, 190 practices and 14 commercial payers remain enrolled in the program—the multi-payer model is expected to have a much bigger impact on practice transformation.

Practices received their first feedback report earlier this year, and The Community Oncology Alliance (COA) invited physicians, practice administrators, and payers, including CMS, to discuss their successes and challenges at the Payer Exchange Summit VII: Oncology Payment Reform, October 23-24, 2017, in Tyson's Corner, Virginia. Here’s a look at some of those discussions:

1. Progress in year 1

Physicians and practice administrators from 2 oncology practices participated on an informative panel to highlight some of the ley learnings over the past year and changes that they had to implement to ensure practice transformation to meet the OCM requirements. Jeff Patton, MD, and Aaron Lyss, MBA, both from Tennessee Oncology, and Lucio Gordan, MD, and Sarah Cevallos, both representing Florida Cancer Specialists & Research Institute, spoke with Basit Chaudhry, MD, PhD, Tuple Health. The conversation addressed the practices’ need for culture change and also identified 4 cost-control pillars that can contribute to lowering the cost of care.

2. Need to educate the staff

In an interview with The American Journal of Managed Care® (AJMC®), Gordon spoke about the need for operational and revenue cycle changes that are vital for an OCM practice, along with the need for efficient communication.

For their large practice, Gordon said, “there was a process of educating the staff, educating the physicians. We are a large practice in Florida. We have about 100+ offices, almost 400 providers, so we had to do webinars to discuss oncology care model, we got physicians involved via e-mail, Q&A, all those things to make it happen.”

3. The elephant in the room: 2-sided risk

A panel moderated by Lara Strawbridge, OCM lead at CMMI, provided the premise for OCM, and went on to discuss practice experiences today and their needs in the future. For Terrill Jordan, Regional Cancer Care Associates, it made sense to “work on a roadmap we didn’t have to build ourselves.” Jeff Hunnicutt, Northwest Medical Specialties, said that while “this program has the legs to be successful” there were some issues with the OCM that they spotted early on, which, according to Ahmad Mattour, MD, Henry Ford Health System, include time-consuming and labor-intensive compliance procedures.

None of the panelists committed to signing on for downside risk. “We need more visibility into the data elements before making a jump,” Mattour said. “It’s difficult to attribute the reasons for a symptom, and patient populations differ. We need more time and data,” he added.

4. Physician incentives for 2-sided risk

Cevallos wants more clarity on the metrics so physicians realize what they are signing up for with 2-sided risk. “Some of those could be financial incentives or ensuring that we’re in compliance with certain measure that the physician feels that is really going to drive quality for the oncology patients,” she told AJMC®.

5. Are oncology practices fully immersed in OCM?

The reviews are mixed. Celeste Roschuni, PhD, user researcher, Tuple Health, presented results from their company’s survey of stakeholders participating in value-based care delivery and the OCM, which was focused on practice variability, stakeholder perception of value/risk, and the transformation process. Based on the survey results, Tuple Health categorized the patients as:

  • The dubious patient
  • The reluctant participant
  • High-expectations patient
  • The pathway participant

The categories were primarily based on how well the practice was prepared to participate and their incentive to do so.

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.

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