1. The biggest opportunities to decrease costs are through drug and inpatient utilization
Not surprisingly, drug spend and avoidable hospitalizations are the largest drivers of cost for cancer programs. But it’s critical that participants analyze total costs associated with different drugs—they need to look beyond the price tag to other charges, such as hospitalizations correlated to specific drugs, to fully understand their value.
Furthermore, a presentation by Ed Bassin from Archway Health showed the wide variation in how cancer patients are discharged from the ED. For instance, one hospital sent 25% of patients home and admitted 75% to the hospital, whereas another sent 80% home and admitted only 20%.
See our study chapter for strategies on how to improve care for your patients in the ED.
2. Data reporting and IOM treatment plans a work in progress for most
When discussing the Six Practice Redesign Activities (participants had to submit their Practice Transformation Plans by September 30), most programs agreed that the most difficult components were the data tracking and reporting and the creation of IOM care plans.
Programs are waiting to see the data deliverable CMMI will require for reporting, but many are already working on strategies to lessen the burden of data collection, such as using the registry and EHRs. And among the 13 components of the IOM care plan, providing cost estimates, creating survivorship care plans, and overcoming physician hesitancy to include prognosis were top priorities.
3. Two-sided risk option opening early, but no one eager to jump in
Initially, the model was going to be only one-sided risk for all participants with an option in performance year three to enter into a two-sided risk model. However, participants received notice in mid-October that the option to enter into the two-sided risk model would open starting in 2017.
The overwhelming consensus was that programs want to wait to see how the model unfolds and learn more about their performance before opting into two-sided risk.
4. OCM participants exempt from most—not all—of MACRA initiatives
Although stakeholders asked CMS to completely exempt OCM participants from MACRA, they will still need to report compliance on advancing care information. However, OCM practices will be exempt from the quality and clinical practice improvement activities.
5. CMMI taking a collaborative—not punitive—approach
As with any initiative of this size, there have been some bumps in the road, including data mix-ups, lack of clarity around the performance bonus calculation, and concerns about the risk adjustment model.
Thankfully, it seems as though CMMI has been open to hearing feedback and suggestions for improvement, so it’s important for participants to continue alerting CMMI to the issues they encounter.
6. Start engaging your private payers now
Although few private payers are participating in the OCM, all cancer programs should start having conversations with their payers about transforming cancer care.
Michael Kolodziej (currently with FlatIron Health, formerly at Aetna) emphasized that payers prioritize three sources of cost in cancer: the cost of chemo, poor end-of-life care, and unnecessary ED and hospital use. As a result, payers are most excited about the potential for clinical pathways and oncology medical homes.
His advice to program leaders was to enhance their payer relationships and get data to better understand what happens to patients outside of the four walls of the cancer program.
Get the latest updates on the OCM
Review updates from our 2018 and 2019 Oncology State of the Union presentations.