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Community Oncology Alliance proposes value-based alternative payment model to reduce costs

The new model aims to provide high-quality, coordinated oncology care at the same or lower cost to Medicare.

Jeff Lagasse, Associate Editor

The Community Oncology Alliance has submitted an ambitious value-based reform model to improve quality, reduce costs and provide additional cancer care services to patients and caregivers.

Known as the "OCM 2.0," the detailed plan is an alternative payment model that was presented by COA to the Physician-Focused Payment Model Technical Advisory Committee, an advisory committee that evaluates physician-focused payment models for the Secretary of Health and Human Services.

It is built upon, and provides numerous enhancements to, the ongoing Center for Medicare and Medicaid Innovation Oncology Care Model, including a proposal for value-based cancer drug selection and pricing. If implemented, the OCM 2.0 model would seek to streamline implementation and operations for oncology practices participating in the program, as well as address the issue of increasing costs of cancer drugs.

WHAT'S THE IMPACT

The OCM is an APM that aims to provide high-quality, coordinated oncology care at the same or lower cost to Medicare. Nearly 200 oncology practices treating more than 150,000 Medicare beneficiaries signed on to the OCM when CMMI launched the program in spring 2016. Although participating oncology practices have credited the OCM with helping them to improve the way they deliver cancer care, these same practices have criticized the program's fundamental shortcomings, including its complexities and burdensome reporting requirements.

As host to a peer-to-peer network of participating OCM practices, COA began formulating a patient-focused payment model that would improve on the OCM. Initially targeted at the Medicare population, the OCM 2.0 model includes provisions for the universal adoption of the model in commercially insured populations. COA's goal has been to develop a flexible and adaptable universal payment reform model for all aspects of cancer care, regardless of payer -- Medicare, commercial insurance provider, or self-insured employer.

In addition to incentives to ensure value in drug selection and pricing, the OCM 2.0 model touts transparency and uniformity, an accreditation program to recognize and monitor exceptional cancer care, and a standard set of procedures and outcomes measures.

The OCM 2.0 payment model follows the standards of the Oncology Medical Home to ensure integrated and coordinated care. The OMH mandates care that's consistent with national standards while empowering the medical oncology team to determine how best to implement it.

WHAT ELSE YOU SHOULD KNOW

With the new model, COA seeks to address the ever-increasing cost of cancer drugs and therapies. OCM 2.0 posits that the greatest opportunity for making progress in value in cancer care delivery requires a focus on managing drug choices and their costs. It incorporates value-based insurance design principles that facilitate providing the correct care for each individual patient while sustaining disincentives for substandard care.

THE LARGER TREND

Just this past April, Humana announced it is launching a value-based oncology program to reward providers for more integrated cancer care for Medicare Advantage and commercial members.

Humana will provide compensation based on an incremental evaluation of quality and cost in several key areas: inpatient admissions; emergency room visits; medical and pharmacy drugs; laboratory and pathology services; and radiology. The evaluation will be determined by metrics that address access to care, clinical status assessments and patient education.

ON THE RECORD

"Implementation of OCM 2.0 will require a higher degree of collaboration, communication and transparency than what has been demonstrated in the OCM," said COA in its application. "Cancer care is complex and in a rapid and constant state of flux due to ever-increasing improvements in biotechnology and biopharmaceutical breakthroughs. It is understood and expected that adjustments will, of necessity, keep pace accordingly and dynamically through the life of the OCM 2.0. All revisions or improvements would be accomplished through regularly scheduled meetings of a small group of appointed decision makers. These individuals will be recognized as leaders of the participating provider and payer groups."

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com