There are some similarities among various value-based payment programs for cancer care, but they are not identical, said Susan Escudier, MD, FACP, vice president, value-based care and quality programs, Texas Oncology.
There are some similarities among various value-based payment programs for cancer care, including the Oncology Care Model (OCM), but they are not identical, said Susan Escudier, MD, FACP, vice president, value-based care and quality programs, Texas Oncology.
How did the OCM compare with other value-based payment programs from commercial payers?
They are similar in some aspects. Now, some of the payers have been a little more prescriptive [in terms of] which drugs they want us to use. I find that a little more challenging, because the way the science develops—if we make an agreement today that lasts for 5 years, it may be out of date in 1 year.
And so, that was one thing that was kind of a good thing about OCM and a bad thing about OCM is that it didn’t include the drug coverage. It was good in the sense that the physicians were not, and practices didn’t have the burden of when the new $100,000 drug came out, they weren’t afraid to give it. The downside is that’s probably why the program didn’t save as much money as they wanted it to, because those new $100,000 drugs kept coming out.
How well do the commercial payers' value-based payments align with one another?
Similar but not identical. They have similar goals, and mostly their goals are things like decreased hospital admissions, decreased emergency room [ER] admissions, and less use of advanced imaging technologies. Those seem to be similar amongst the different programs.
I think what's a bit challenging is some of them are a little better at analyzing the data and getting it to us, and some are not, and it's harder to tell how we're actually doing in the program, because, for example, one thing I would really like to see is to have more real-time information for things like hospital admissions. Because the time to intervene with that patient who is frequently hospitalized or frequent ER visit is right away. It’d be nice to have a closer interaction with the payers, because they’re getting a bill, to say, “Hey, by the way, do you know your patient is in the hospital?” Because we don't always know. Sometimes they've gone in for their cardiologist or for pneumonia or something unrelated, but then we have a chance to figure out what we can do to help them stay healthy at home instead of going to a hospital.