Evolution of the ACO Model to Meet the Needs of Oncology Patients and Payers

Julian Malinak, MPH, finance lead for the pioneer accountable care organization (ACO) and next generation ACO models and technical advisor for financial policy at CMS Innovation Center, explained that CMS, as well as other organizations, are pushing away from the traditional fee-for-service methods by creating delivery models like ACOs and employing various tools and services, such as bundled payments, and are beginning to examine these methods in the oncology setting.

Malinak spoke alongside Scott Gottlieb, MD, practicing physician and resident fellow at the American Enterprise Institute, and Ted Okon, MBA, executive director at Community Oncology Alliance, during a panel discussion aimed at understanding how the ACO model has evolved to meet the needs of oncology patients and payers during The American Journal of Managed Care’s 4th Annual Patient-Centered Oncology Meeting. The discussion was moderated by Dennis P. Scanlon, PhD, professor of health policy and administrator and director of the Center for Health Care and Policy Research at The Pennsylvania State University.

“We’re moving towards value-based payment and ACOs,” Malinak explained. “We’re trying to provide a variety of different options for risk-taking. We realize that with oncology, we’re not going to just place everyone into 2-sided risk. Data sharing is very important and a big benefit of a lot of our models and the concept of a medical home is something we think about a lot too.”

Okon compared the ACO model to what a Home Owners Association looks like and how it performs. Essentially, the association is a group of homes that individuals go to for permission on major home repairs, like cutting down trees or painting the shingles a new color. The association mirrors how the Oncology Medical Home performs, which Okon said has seen successes with increasing the quality of life for patients while at the same time decreasing costs.

“It’s a community of different houses getting together and the oncology medical home is just that—it’s your home,” Okon explained. “And, frankly, I think in oncology—and I feel really strong about this—is that you’ve got to first look at your own home. And what does that mean? That means actually being able to measure quality, measure value, and then be able to understand how you can compete in a larger ACO framework because again, oncology is the specialty that could sort of bust the bank if you will in terms of the new, more expensive therapies that are coming out.”

Gottlieb suggested that truly implementing the ACO model into the oncology setting may be more difficult than in other settings, as there are a lot of complexities that come out of cancer care.

“In a field that’s as fast-moving as oncology, where you see rapid innovation and you see rapid adoption of that innovation, reimbursement models that are predicated on backward-looking measures of risk and backward-looking measures of cost are going to inevitably slow down the introduction of that innovation and that technology,” he said.