Value-Based Care and OCM: The Federal Program Ends, but our Focus on Value-Based Care Continues

Before 2016, there was little going on regarding value-based care in oncology. That changed with the introduction of the oncology care model (OCM), the intention of which was to better align financial incentives to drive improvements to care coordination and appropriateness, as well as expand access to care for patients undergoing chemotherapy.

After six years, the pilot program is at its end. OCM encouraged participating practices to improve care and lower costs through an episode-based payment model that financially incentivized high-quality coordinated care. Fine in theory, but not so easy in practice.

Despite its demise, OCM significantly impacted the practice of oncology, and great strides in patient care were nonetheless realized.  

The Benefits of OCM

Participating in OCM helped transform practice operations within the AON network to focus on patient experience more than ever – rather than simply delivering care. Additionally, the investments we made in services and a quality-based care infrastructure to support associated OCM program requirements will continue to deliver value to our patients and practices.

OCM required the delivery of care plans directly to patients, which our physicians did excellently.  Before OCM, most in oncology care were not driven to provide care plans and documentation directly to the patient. Oncology was about care delivery less than it was about coordinating or including the patient in the care. OCM required that patients received information about their care plans in a shareable format that patients could use as they wanted.  

With the cessation of OCM, the most significant disadvantage for patients is that they may face a more difficult task of acquiring patient information in which they can act upon. For example, when a patient is newly diagnosed with cancer, they typically retain very little of the information discussed around prognosis, treatment options and treatment plans. Compliance with OCM data guidelines helped patients retain this knowledge.

In fact, the required care plans were one of the best things to come from OCM because they easily translated to meaningful, patient-friendly paper documents outlining all the information a patient needs to understand their diagnosis and treatment. Though this information has always been in the patient’s chart, through OCM they also had something tangible to share with their families and loved ones. This shareable information led to patients being more engaged in their care and asking questions related specifically to their treatment plans rather than engaging in a more nebulous manner. That’s been a positive impact, useful for patient navigation.

What’s Next

Participating in a large value-based care arrangement like the OCM has been invaluable for AON, our practices, physicians, and patients. While participation was voluntary, most who took part did so by embracing it fully. That is why I don’t believe value-based care practices or the principles of OCM are going away – nor do I believe any other healthcare providers want it to go away.

Unfortunately, the most significant problem before OCM was that payers were not fully prepared for how to address value-based care in oncology. Treating cancer is very expensive and oncology drug prices are unpredictable, which is likely a significant deterrent for some commercial payers when it comes to developing any type of shared savings program for community oncology practices. The overwhelming challenge faced by payers is alignment of interaction and reimbursement. It is a complicated, detail-driven challenge where various payment models and contracts created roadblocks to streamlining payment mechanisms. 

When OCM officially concludes on June 30, 2022, there is no other quality program coming online in its place – making it a challenge to maintain an oncology value-based care program. Outside of organizations like AON, there are likely some very real challenges ahead for practices as they attempt to do so. Most invested in services and infrastructure to support participation in OCM, and will likely lose at least some momentum without another value-based model to follow, especially regarding data collection and dissemination.

However, for practices within the AON network, basing care on quality over all else remains a priority. We continue working with our practice partners to ensure training and education related to value-based care. We make clear the benefits and put in the work to prove the value of value-based care for patients and practices. We’ll continue to follow the structure of OCM – every practice transformation effort that we put into place will continue – because it is flourishing. We will not revert to pre-OCM care.

Our patients are the ones who win in the end, and that’s why we’re here – to provide the very best care for our patients, with or without a formal OCM program.