Bo Gamble Discusses Themes in Oncology Care Reform Ahead of COA Payer Exchange Summit


Bo Gamble, director of Strategic Practice Initiatives for the Community Oncology Alliance (COA), previewed the COA Payer Exchange Summit on Oncology Payment Reform ahead of the 2-day virtual meeting on October 27-28, 2020.

Bo Gamble, director of Strategic Practice Initiatives for the Community Oncology Alliance (COA) discussed the COA Payer Exchange Summit on Oncology Payment Reform ahead of the 2-day virtual meeting on October 27-28, 2020. Gamble discussed the meeting's virtual format and highlighted key themes of the panel "COA’s Oncology Care Model 2.0: A Comprehensive Solution for Providing High-Quality, Affordable Cancer Care" that he will be moderating.


This is now COA's second major meeting in a virtual format. Did you learn anything during the annual meeting that you are bringing to the Payer Exchange Summit?

Not so much as more preparation. In some cases, we had some little hiccups just in bandwidth, where participants' bandwidth was not as good. But truth be known, we were very pleased with how the first [meeting] turned out, if you saw anything. It was kind of a rush decision, given the fact we were planning to go live, and now we had 30 days to change our mind. So it worked out very well, all things considered. ... The logistics seemed to work pretty well, so we're trying to just keep the same technique and even do it better, hopefully.

Last year, the discussion concerned whether practices would embrace 2-sided risk. How are practices who took that step faring during COVID-19?

We were involved in supporting OCM from a year before it started. We have a good network of participants, we gave them feedback suggestions for the model. So, as soon as it launched, we said, "OK, let's get to it." And we created a network of support for the team; we had about 80% of all the participants in our closed network. We did calls every month to learn and educate and spotlight changes. But since they made that decision in December—either you got a performance-based payment, or you have to take 2-sided risk, or you're out. Since that time, our communications have been minimal, just because they've made that decision.

From just a standpoint of cancer care, we have seen a real big drop in referrals. We saw it pick up again in June or July. Now we're seeing it slide a little bit, but that's everywhere. That's just not for the participants. That's all referrals, and we're trying to figure out what we can do to help that as best we can, because it's not like you can create business, if you're in cancer care. So, a lot of it is just trying to get practices to hold on and do what they can and manage your staff accordingly. Get creative and follow up with your patients.

We have been very active in the changes to telehealth and how those telehealth changes can be implemented. I'd probably say we were one of the first out of the gates. Within 30 days of the changes, we had had webinars with close to 1000 people. Telehealth was one of those projects that could take anywhere from 9 months to a year, and people were implementing it in 24 hours. So we were sharing how people that are doing well were doing it, because that staying in touch with patients was very key to care. And so it's tough for patients, tough for providers and for care teams. We had to work and they had to work through a lot of logistics, but from an OCM standpoint, we were like, "OK, let's kind of watch things and support where we can."

What will be some key discussion points during the panel on COA's Oncology Care Model 2.0?

We put out a paper where we have identified 35 different payment models out there in cancer care—35! If you're a cancer care team in 1 state that has 7 models, you have to know what model is this patient that's coming in the door? We need to comply with their guidelines. So if you think about there's that many models, and every one of them are different. Every model's got at least 3 major components. You've got the care processes, the care delivery, the care, then you've got the payment methodology. How are you going to do something different is going to be based on quality and value? And then you've got the measures, which are the sort of middle man that says, "Okay, this is how you're going to deliver care." How do you know the care get delivered that way, and therefore measure it and then use those measures in the payment process?

Traditional healthcare is all about utilization. You go to the doctor, whether he tells you the right thing or not, he's going to get paid the same way. It's about consumption or utilization, sadly, and that's one of the things we're trying to fix. We need to promote accountability so that if the right thing is done, reward them. If the right thing wasn't done, then don't reward them. Let's drive toward quality improvement.

So within OCM, 2.0, we're trying to focus on the care delivery pieces to create standards so that all interested parties that have some sort of investment in the care reimbursement process, have something they can look at, that says, "Oh, that's excellent care, that care's better than anybody else's." There's measures to prove it, they've got surveyors that make sure that happens. Therefore, for model, let's try to point to that everybody. So not only for the care teams to implement it, but then the providers and the payers to recognize it, employees to recognize it. So they can say, "Hey, this person has this classification, I can see it, the measure should show up that way. Let's use them in the model."

After that, then there's different aspects of different form model, for example, you've got something called attribution. That is how a beneficiary is assigned to the model, and we've created OCM 2.0 so that there are tiers in complexity. If you're new to this game, what's the simplest thing I can do today, do this, if you're a little more advanced into this, if you're advanced, if you're far advanced, you've already done these two things, you're ready to do something different, then let's do this form of attribution. Let's do this form of shared savings.

OCM 2.0 takes these components—there's about 7 or 8—and for each component, we're saying, "Okay, here's an entry-level position. Here's an intermediate, here's advanced." You pick and choose, and you don't have to say everything's intermediate, or everything's advanced. [You can decide], "Well, I don't feel comfortable over here, so I'm going to start over here. But here, I've made some good progress, so I'm going to use this instead."

So OCM 2.0 is really a map or a blueprint, or foundation to be in any payment reform model, regardless of payment. We're not dictating or prescribing any particular way to pay for it. We're just saying you need to demonstrate that you're high quality, high value in cancer care. Here's the path to do it. Then begin working with your local employers or local payers, on the payment piece.

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