Practices deciding whether to join Oncology Care First or another oncology alternative payment model (APM) will need a clear understanding of how big of a transformation they’ll need to make to their practice, said Mike Fazio.
Oncology practices deciding whether to join Oncology Care First or another oncology alternative payment model (APM) will need a clear understanding of how big of a transformation they’ll need to make to their practice, said Mike Fazio, senior vice president of Client Services at Archway Health.
There are a lot of oncology alternative payment models (APMs)—how are practices making the decision to go into Oncology Care First or into another APM?
Well, you know, especially with OCF, the big deciding factor comes once the pricing specs released, and if CMS provides data ahead of time before making that decision. So that's something that they do in in some of the other voluntary models like BPCI [Bundled Payments for Care Improvement] advanced in ACOs (accountable care organizations], is you understand the contract and model that you're getting into signing that contract with CMS and saying, “I'm moving forward.”
So, if risk is as big of a component in OCF as we think it will be, practices should really understand what they're getting into as far as risk and the pricing model, which is really out of their control. What is in their control is understanding the cost side. And can they move the needle on those costs of care? So, drug costs, reducing hospitalizations, and all the things that current OCM participants have learned.
So, the decision around OCF depends on: is the model a good fit for a practice? And to make that decision and look at your opportunities, you need data ahead of time, something that CMS did not provide with OCM during the application phase in 2015 but is likely to release as part of OCF like they do in other programs like BPCI, Advanced. So, the participation really depends on how transparent they are on the pricing model, the benchmarks that they'll use, and the risk exposure that practices will be expected to take on. And that's all weighed against.
And then if you're in OCM, today, but you have a good sense of how much work OCM is to implement and run. Those that have been on the sidelines should be talking to their peers about the investment in time and resources for something like OCM, which OCF will certainly have, and weighing that against some other programs—how big of a lift is it really? I mean, you know, OCM and OCF are transformative models. So, it affects a large portion or the majority of patients that come through the practices. And so, it's not just you're dabbling on a side project, it's a movement. It's really transforming your practice and are you ready to do that or not is a big decision. So, is the pricing model in the program a good fit for your practice and for your patient population? And are you ready to make the investment in time and resources to take this on? Because it can't just be a side project.
And so, with the other APMs, it's the same evaluation. It is: what are the time and resources involved to run those programs? And are they side projects or are they really affecting your entire practice? And so those are big considerations to make before entering any of these if they're voluntary.