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The challenges of participating in the Oncology Care Model—and why 3 providers say it was worth it

By Lindsey PaulAshley Riley

September 23, 2022

    In our recent Reflections on the Oncology Care Model (OCM) webinar, three panelists discussed their experiences participating in the OCM. Read on to learn about the biggest challenges they faced and how they benefited from participating.

    The challenges

    1. Reducing total cost of care

    OCM participants were tasked with reducing total cost of care while maintaining high care quality. But beyond implementing the six required enhanced services, they had to figure out how to reduce costs on their own.

    To succeed, participants built out new data analytics capabilities and got creative about transforming care practices. The required investment was significant, and despite implementing changes, some of the panelists' organizations still struggled to reduce costs below their target amounts.

    According to the panelists, this was especially difficult at the beginning of the OCM but continued to be an issue throughout the duration of the model. Smaller practices in particular saw significant variability in performance across the model's performance periods.

    2. Patient attribution

    Under the OCM, patients were attributed retrospectively to the practice that conducted a plurality of their visits during the performance period. As a result, two panelists struggled to identify in real-time which cancer patients would be attributed to their practices.

    This made it difficult for the practices to predict how they were performing and make timely adjustments. Incorrect patient attribution also had direct financial consequences since practices owed recoupments to CMS for patients for whom they mistakenly billed monthly enhanced oncology services (MEOS) payments.

    One of the panelists expressed relief that CMS resolved this issue in its next medical oncology alternative payment model, the Enhancing Oncology Model (EOM), by attributing beneficiaries to the practice that provides the first qualifying E&M visit after chemotherapy initiation.

    3. Utilization of novel therapies

    One panelist talked about how despite the novel therapy adjustment, OCM cost targets failed to keep up with innovative but expensive treatments, such as checkpoint inhibitors, that entered the market during the model. This meant practices that adopted these innovations more quickly than their peers were penalized.

    The panelist commended CMS for making changes to the novel therapy adjustment methodology in the EOM. However, he still felt that to effectively account for the use of potentially high-value novel therapies, CMS needs to utilize more clinical data in its methodology rather than just claims data. Another panelist suggested CMS exclude drug costs from the model entirely and instead focus more on clinical pathway adherence to promote high-value treatment decisions.

    The benefits

    1. Access to additional staff

    The OCM provided the incentive and funding (via MEOS payments) for practices to hire more nurse navigators, social workers, and other staff to support patient care. Outside of the OCM, cancer programs often can't hire as many of these support staff as they'd like because they provide non-reimbursable services.

    One panelist mentioned that the OCM also gave him leverage to request more staff funding from his hospital's senior leadership, including navigation staff and extra IT support.

    Through these investments, the panelists found that their practices were better able to serve their patients, with one panelist even seeing an improvement in timeliness of care.

    2. Development of tools to manage high-risk patients

    OCM practices implemented new tools for assessing and managing patient risk.

    For example, one panelist's organization developed an EHR-based risk assessment calculator that is used to conduct proactive outreach to high-risk patients. The calculator identifies high-risk patients based on social determinants of health, pain scores, and other factors.

    The same practice also implemented a tool that provides real-time alerts about ED visits and inpatient admissions among its OCM patients, allowing it to better support these patients and minimize costs.

    3. Changes to practice culture

    Each of the panelists talked about how the OCM catalyzed culture change at their organizations. As the OCM progressed, panelists saw their teams' attitudes toward the model's requirements shift, and they began to prioritize value-based care practices during care delivery.

    For example, one panelist noticed a growth in independence among the clinical staff at his practice, with different staff members taking it upon themselves to iterate on elements of the care process.

    Another panelist noted that his team members became more open to data-driven quality improvement and clinical pathways utilization. He believed that the internal expertise in using claims data analysis for patient attribution that his team developed during the OCM will benefit the practice long after the end of the model.

    Though OCM participation certainly had its challenges, each of the panelists viewed it as a success for their organizations. They are now evaluating EOM participation as a potential next step to continue with the progress they made during the OCM.

    To learn more about how the panelists are evaluating EOM participation, read our blog on 4 factors to consider when deciding whether to participate in the Enhancing Oncology Model.

    4 factors to consider when deciding whether to participate in the Enhancing Oncology Model

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    In our recent Reflections on the Oncology Care Model (OCM) webinar, three panelists discussed their experiences participating in the OCM and their thoughts on CMS' new Enhancing Oncology Model (EOM).

    Here are four key factors they're considering in deciding whether to participate in the EOM.

    Read more

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