Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology, talks about lessons learned from the Oncology Care Model (OCM) and Medicare that are being used to innovate toward value-based care.
As the Oncology Care Model (OCM) ends and we wait for the next model, there is a lot of innovation happening in the commercial sector, said Stephen Schleicher, MD, MBA, chief medical officer of Tennessee Oncology.
Where do you see advances in value-based care going from here? What is Medicare's role in these advances?
Great question. Medicare obviously was extremely influential in teaching us about value-based care in oncology through the Oncology Care Model. Oncology is very different than other types of specialty care, especially primary care, because there are 100 different diseases within cancer, so every patient is different. How do you account for that? Unfortunately, whether we like it or not, the elephant in the room, drugs make a huge part of cost. How does that go into a model or really incentivize to keep people out of the hospital yet Keytruda, one of the best drugs we have, is still very expensive. How do we balance all that?
Medicare taught us a lot. Now as OCM is ending and hopefully just a bridge toward something else for Medicare, I really applaud our commercial payors—at least in Tennessee I can speak of—that have come to us either with attempts to cocreate models or bring value-based care models to us, largely stemming from the Oncology Care Model. Our hope is to make each model that much more innovative so that we can continue to drive value, even in the absence of a Medicare model right now.
Some real pluses of commercial payors: It's obviously very different for a large practice to talk to a large commercial payor like Blue Cross, who we just cocreated a medical home with, than for us being 1 of 180 practices talking to Medicare about OCM. We really get a chance to codesign models, which is excellent, because it allows us to take what we've learned being participants in a 5- or 6-year government pilot and apply that to a more nuanced model that fits our patient population and really align where costs are and what we can actually control to influence that. That's 1 big plus with commercials, the ability to cocreate.
Two, data sharing. A problem with Oncology Care Model, it's 18 months until you get the full reconciliation report and know how you did. With commercial models, where it's just 1 big practice, 1 large commercial payor, we're able to share data much more quickly and get feedback to drive innovation much faster than 18-month PDSA [Plan-Do-Study-Act] cycles. That's another big plus.
Third, it expands the population that gets access to these great services that we've begun to offer through OCM and are now able to apply it across broader patient populations—so more patients benefit. One thing that comes up a lot is health care disparities. We found that a lot of what we've learned and created in response to OCM disproportionately impacts patients living in rural areas, which is excellent. Engaging through PROs [patient-reported outcomes], our care navigators and our coordinators, really a large population of these patients who live 30 miles outside of metropolitan areas, and being able to take those great benefits and apply it to the large commercial population, is another big win.
Right now, as OCM really ends and we wait for the next model, a lot of innovation is happening with commercial and it's a great extension from what we learned from OCM. Hopefully we continue to innovate even faster and bring that back to the Medicare population when the next model comes.
To hear more from Dr Schleicher and Tennessee Oncology, join us at The American Journal of Managed Care®’s Institute for Value-Based Medicine® April 21, 2022.