ASCO, COA Release Updated Standards for Oncology Medical Home

SAP Partners | <b>Community Oncology Alliance (COA)</b>

The new standards come as community oncology practices await word on the future of the oncology care model, which will expire in 2022.

The American Society of Clinical Oncology (ASCO) and the Community Oncology Alliance (COA) today released updated standards for the Oncology Medical Home (OMH), putting renewed emphasis on the importance of palliative care and ASCO’s Quality Oncology Practice Initiative, which seek promote safety and best practices in the administration of chemotherapy.

A joint statement from the 2 groups states that the new standards offers a roadmap for delivering “equitable, high-quality cancer care.

“In releasing the new standards, ASCO and COA seek to achieve a broad consensus among all stakeholders—including patients, clinicians, payers, purchasers, and employers—on what patients with cancer should expect and receive from their cancer care teams,” the groups said. Details on the new standards were published JCO Oncology Practice.

In their statement, ASCO and COA say that the standards “provide an opportunity for the entire oncology community to work towards a value-based model of care that will benefit all patients with cancer.”

“Every single patient has the right to high-quality, evidence-based, and cost-effective cancer care. However, our challenge as clinicians and as a broader oncology community has been to define what that high-quality cancer care looks like,” ASCO President Everett E. Vokes, MD, FASCO, said in the joint statement. “These new, comprehensive standards will remove ambiguity and serve as a strong foundation for all stakeholders to work together to ensure that every single person receives the care they deserve, throughout the entire patient journey.”

COA members have been working with OMH standards since 2012; the effort grew out of an earlier initiative on the patient-centered medical home. The idea of creating standards for care coordination, informed decision making that involves both doctor and patient, and communication standards that ensure patients and families are active participants in cancer care—that care is something done with them, not to them—guided the development of CMS’ Oncology Care Model (OCM), which is set to expire next year.

“These new OMH standards provide oncology practices with a single set of cancer care delivery expectations that benefit patients, payers, employers, and other stakeholders,” said COA President Kashyap Patel, MD. “As practices transition into value-based care delivery, those that adopt this framework will be able to focus on a standardized process that measurably demonstrates high-quality, patient-centered, and efficient care.”

The new joint standards are the basis of an upcoming 2-year, ASCO-led OMH certification pilot, which will be detailed over the next few months. The standards will cover 7 areas of cancer care, including 2 new areas, or domains, that have been designed since the original set. They are:

(1) patient engagement, which includes shared decision-making

(2) access to care in the right place at the right time

(3) value-based treatment, including documentation of the use evidence and clinical pathways, and referral to clinical trials

(4)access to equitable, comprehensive, and coordinated, team-based care

(5) continuous practice quality improvement, including the use of data and patient-reported outcomes

(6) advance care planning, palliative, and end-of-life care, including discussions of goals

(7) adherence to chemotherapy standards based on QOPI certification program standards

Bo Gamble, COA’s director of Strategic Practice Initiatives, told The American Journal of Managed Care® that the new standards were developed with multistakeholder a team of physicians, a nurse, patient advocates, and leaders from employer coalitions who fund healthcare. The updated standards reflect the addition of the domains to elevate the importance of end-of-life care and adherence to QOPI certification, he said.

The hope is that payers can coalesce around a common set of pay-for-performance standards, as least with regard to care delivery. All oncology payment models have 3 basic elements, Gamble said: care delivery, payment methodology, and performance measures. He pointed to research COA presented that showed its members were dealing with up to 35 different oncology payment models across public and commercial plans.

“It’s gotten crazy,” Gamble said. Such diversity becomes impossible for practices to manage. It would be preferable, he said, to reach agreement with payers to at least standardize the platform for care delivery, with payers differing on the payment methodology.

Some experts have said a multimodel system can be unethical, if physicians feel the evidence points to one method being superior.

Will payers buy in? Gamble is encouraged by early discussions as COA works with ASCO on the upcoming OMH certification pilot. “So far, so good,” he said. Compared with the last iteration of the OMH, “this program is much more structure and goal oriented.”

This pilot, he said, will address a major weakness of the current OCM—a dashboard will gather clinical data to offer real-time information with comparisons to peers. The information delay in the current Center for Medicare and Medicaid Innovation (CMMI) program means providers find out about weaknesses well after the fact.

With oncology practices still waiting to hear what will come after the OCM ends in 2022, “We hope that CMMI will take notice,” he said.