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Oncology Care Model: Stakeholder Support



Bruce Feinberg, DO: Let’s talk about partners who do so well, like providers and insurance companies. If we look at the Oncology Care Model [OCM] from the standpoint of commercial insurance, you would think that what was just described by Ted would be the perfect intro to, “OK, guys, you’ve had a chance to watch the experiment. How are you going to do it?” Are we seeing anything that gives us an idea? Humana Inc just today announced, what was it? The Oncology Care Model is now the Oncology Model for Care?

Kavita K. Patel, MD, MS: Right.

Bruce Feinberg, DO: So creative.

Kavita K. Patel, MD, MS: Right, I agree. We are seeing it, but I still think that they are taking just pieces of things and then saying, “Well, you know, here’s something that’s a little bit easier to bite off.” That’s largely a reflection of the fact that Medicare does have the largest share of patients, in terms of volume, with cancer. When you’re in different markets, whether you’re Humana, Aetna Inc, Cigna Corp, or a local Blue Cross Blue Shield provider, you’ll never have that volume. Statistically, you just won’t.

Bruce Feinberg, DO: I don’t understand how an Aetna, you know...

Kavita K. Patel, MD, MS: Can make that work.

Bruce Feinberg, DO: Can make that work, right. In most markets you’re a single-digit percentage in terms of the penetration of cancer patients.

Kavita K. Patel, MD, MS: At best it may be double, but low double. I do think people are doing that, but they’re not doing what we’ve described. However, I would say that with some of the OCM 2.0 conversation, the most interesting uptake is employers. Now there is a conversation at large Fortune 500 workplaces about employees with cancer. But we do not hear that they’re getting the kind of care that they want, so we are now going to try to drive that conversation more directly.

Bruce Feinberg, DO: You have Pitney Bowes Inc and Eli Lilly and Company. But there have been just a handful of employers that really have stepped in over the years.

Kavita K. Patel, MD, MS: But there’s more.

Ted Okon, MBA: You’ve got the National Business Group on Health. You have literally met with Midwest Business Group on Health. And you have state business groups on health that actually represent… There’s a really novel program going down now in Florida between Florida cancer specialists and some of the employers down there, called Florida Oncology Connections Program. You see these offshoots. I think to dovetail what Kavita said, we’re actually looking at this OCM 2.0 not as a Medicare program, but rather we’re looking at it as a universal model. This is something that an employer and a provider—yes, Bruce, they traditionally have been at loggerheads—are working a little bit more closely on. Especially on the employer side, as Kavita said, you can take and modify it. It’s not just 1 size fits all. The basic model is there, but you can modify it. We’re starting to see that actually happen.

Bruce Feinberg, DO: Rich, in your program at Columbia University Medical Center, do you know of any models in which large employers, regional employers, are directly working with the university in this regard?

Richard D. Carvajal, MD: No, I don’t.

Bruce Feinberg, DO: We’re seeing this in some markets. In Seattle, Boeing Co has done it and bypassed the insurer.… I don’t know how many examples there are, but this is probably the largest example.

Ted Okon, MBA: They’re starting and you’re going to see more. And literally if you look at the National Business Group on Health Survey from the fall of last year, you will see a basic dissatisfaction on the part of large employers with the status quo, with the insurers, and with the PBMs [pharmacy benefit managers]. That’s why they’re taking a more active interest in healthcare. And look, as the population gets older and as the population gets more unhealthy, we see more incidence of cancer.

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