With COVID-19 on the forefront of everyone’s mind, it is difficult to remember that the decade started out with an uplifting headline in cancer care: the largest single year drop in cancer mortality. We also saw emergence of the next generation oncology model, Oncology Care First (OCF), which comes on the heels of a successful first-of-its-kind model, the Oncology Care Model (OCM).
As you shuffle through the countless articles, studies, and theories, there are many factors that play into the reduction in cancer deaths, many associated with science, demographics, society, and a change in the delivery of healthcare. Regardless of why, the news is a welcome development at a time when the nation is in the midst of a pandemic that continues governing our lives.
I am fortunate to be a frontline witness to one of the best stories in cancer care to hit our inboxes, thanks to my role within American Oncology Network (AON), one of the fastest growing oncology networks in the nation. I am charged with protecting community oncology by securing funding through revenue cycle processes. However—and more importantly—my role challenges me to think about how cancer care is constantly changing in our drive for better outcomes, enhanced delivery methods, lower costs, and a focus on value, which in turn requires that we challenge the “norm” of reimbursement methodologies.
A Quest for Innovation
Since its inception in 2018, AON has helped lead the charge to create new methodologies through key payer partnerships such as with the Center for Medicare & Medicaid Innovation (CMS Innovation Center) and its Oncology Care Model (OCM). This commitment to change has helped drive AON’s growth. For example, its involvement with OCM was an important factor behind the decision by Genesis Cancer Center—which has been part of OCM since the initiative began in 2016—to partner with our network.
Born out of a group of seasoned oncology professionals seeking to create a first-of-its-kind oncology focused value-based model, AON ensures that its practices have a seat at the table to participate in models with the potential to transform cancer care. This includes the OCM, which permitted oncology providers to improve health outcomes for cancer patients through specific reimbursement methodologies that reward value over volume. And, as its network proliferates, the AON philosophy provides its oncology partners with the flexibility to change with emerging methodologies such as Oncology Care First (OCF), introduced by CMS Innovation Center in late 2019.
As AON develops an oncology network that, while geographically diverse, is interconnected through a rapidly growing dichotomy of oncologists and a cancer team focused on building an infrastructure to support declining cancer rates, partnerships and advanced reimbursement methodologies like the OCF are key. Payment models are complex, and the most critical part of these models permits the autonomous delivery of cancer treatments and support services—something AON continuously promotes among our local care teams.
Benefitting Physicians, Patients and Outcomes?
So now the question is whether there is a correlation between the adoption of a first-of-its-kind oncology focused payment reform model and the historic decline in cancer mortality rates. Within this next payment model, it is proposed that physicians who participate in OCF will still have the freedom to manage patient care and run their practices as they see fit. However, with OCF, they have better access to a pool of data from OCM that can guide clinical and administrative decisions and connect any dots between the model and outcome trends.
With this next generation of reimbursement, AON’s focus is on infrastructure development to support the balance between the various elements that consumers expect: value, outcomes, accuracy and timeliness. All of which is more important than ever. The network’s model is positioned to support this shift in attention as we can deliver the administrative expertise, infrastructure, and economies of scale necessary to optimize the transition to value-based care initiatives like OCF.
Wave of the Future?
OCF has great potential to be a win for independent practices, their physicians and, most importantly, their patients. This is particularly true for those that partner with networks like AON. Doing so not only streamlines participation in initiatives like OCF with access to administrative expertise and the technology required for data collection requirements, but it also helps optimize involvement by offering turnkey access to newly covered benefits like extended care services in areas such as nutrition, anxiety and depression.
Most importantly, it is a partnership that puts them on solid footing for the future by reducing costs and improving quality of care—without sacrificing their clinical autonomy.