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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.

The Future of Oncology: Value-Based Care

July 2016 marked the start of oncologists looking at a new way to manage cancer care with a shift from fee-for-service to value-based care, prompted by the launch of the Oncology Care Model (OCM) by the Center for Medicaid & Medicare Innovation (CMS Innovation Center). Today, CMS Innovation Center is expanding on this foundation with Oncology Care First (OCF)—a next-generation model that will phase out OCM and further emphasize the benefits of adopting value-based care models that favor care quality and outcomes over quantity of services provided.

Thanks to the success of OCM and other programs, the adoption of value-based care is advancing rapidly, delivering improvements in collaboration, costs and quality that oncology should embrace sooner rather than later.

Enhanced Collaboration

Collaboration is one of the most critical components of value-based care. Enhanced coordination of care among healthcare providers can help improve patient outcomes and lower costs by decreasing unnecessary hospitalizations and eliminating emergency room visits.

Routine interdisciplinary care team meetings allow for enhanced collaboration and communication among members to ensure a patient’s needs are being met and timely follow-up is in place. This team-based approach assures the entire care team is focused on the same goals of care for each individual patient.   

Because value-based care is still relatively new, it is important to discuss with clinical and non-clinical team members the specifics of the model and the importance of collaboration, as well as how it benefits the patient.

Driving Down Costs

There are typically three main cost drivers facing oncology practices: hospitalizations, chemotherapy agents and variable resources. Driving down the costs associated with these drivers, while still providing top-shelf care, is essential to a successful transition to value-based care.

Education is a key component to effective implementation, and the primary focus in this case is the patient. Helping patients understand which symptoms of chemotherapy treatment merit a trip to the emergency room vs. an office visit with their oncologist or primary care physician can decrease unnecessary and costly ER visits. Strategies such as a “Call Us 1st” campaign can be an effective method to encourage patients to call their oncologist or physician first to see which route is better, assuming the situation isn’t life-threatening.

An effective triage system with nurses conducting proactive outreach to high-risk patients is another strategy that can deter the need for higher-cost interventions. Along those same lines, ensuring patients can always reach a live person by phone rather than having to leave a message—then worry about a call back—can also decrease costs associated with unnecessary emergency care.

Other cost containment resources include:

  • Social workers, who can provide oncology patients and their loved ones with invaluable support throughout their cancer care.
  • Nurse navigators, who guide patients and their families throughout the entire oncology care journey.
  • Dietitians, who can educate patients on proper nutrition to lessen the side effects of treatment and improve recovery.
  • Pathway adherence and evidence-based treatment options, such as the National Comprehensive Care Network (NCCN), which can help physicians and pharmacists identify less expensive, but still highly effective, drugs and treatment.

The Role of Data

As important as collaboration and cost containment measures are to the success of a value-based care model, they cannot happen without a solid foundation of data. For example, participating in state health information exchange initiatives carries unique benefits in the value-based care environment, such as the ability to connect with laboratories to access test results in real-time or being able to see when or if a patient was admitted to or discharged from the hospital.

Comprehensive patient data allows oncologists to better evaluate treatment outcomes and determine what, if any, changes could be made to prevent ER visits or admissions. It can even provide the basis for deployment of advanced communications such as texting medication and appointment reminders.

The data challenge is two-fold: it requires the right technological foundation and the understanding of data and how to use it in practice transformation efforts.  

To overcome these challenges, the American Oncology Network (AON) built a Value Based Care team that collaborates with physician champions to review data and make recommendations for continuous process improvements. The development of a quality care committee consisting of representatives from various departments who are champions of the value-based care model has also proven to be effective. This committee of peers can demonstrate the value of data in reducing costs while improving outcomes.

Partnering with a Network

Transitioning to a value-based care model can be difficult and requires a level of infrastructure and manpower that many independent practices do not have—limitations that have forced some practices to pull back from its adoption.

However, partnering with a network such as AON can empower practices to embrace the potential of OCF. AON can provide the support and resources that set the stage for success in a value-based care environment. Among these are the technology and expertise to not only capture and share robust patient data, but also help transform hard-to-read metrics into action items.

Pharmacy services, care coordination, back-office support and a plethora of other tools are also available to AON practices to help them get—and stay—on the right track with value-based care.

A Proven Approach

While the model itself is relatively new to oncology, value-based care has already proven its effectiveness at improving patient care and driving down costs.

Value-based care isn’t going away. The sooner oncology practices embrace it, the sooner they will realize the many benefits it can deliver.

Oncology Care First: The Wave of the Future

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.