July 1 marked the one-year anniversary of the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM), a bold new program focused on providing higher quality, more coordinated cancer care for Medicare beneficiaries with attention on managing costs. The program provides upfront payments to fund oncology practice transformation with the expectation that oncology practices will use these funds to provide enhanced services to patients, submit quality metrics and learn from data sharing.
The OCM is a large, complicated program that calls for a new way of delivering care for the 190 participating oncology practices, including 14 in The US Oncology Network. Some practices are adjusting well to program requirements, while others struggle to keep up with the multiple rule changes and frequent updates.
Although we won’t know how well practices are performing in the program until Medicare delivers their first reconciliation reports six months from now, practices have been taking the OCM seriously and are striving for high performance.
Practices have identified three critical success factors
Even though we don’t have final data yet from Medicare, our participating oncology practices have identified some critical success factors that other participating practices can replicate:
- Patient Experience. Most practices have adopted team huddles as a way to identify and help at-risk patients. The huddles have been successful in helping patients who have needs that might otherwise go unmet.
- Care Coordination. Practices are more proactive in coordinating care with other entities in the health care environment, such as hospice, urgent care centers, social workers and other providers.
- Advance Care Planning. Advance care planning, an important component of the OCM, is a critical part of quality care often overlooked. Many patients fall through the cracks when it comes to documenting their values and wishes. Good advance care planning helps ensure patients receive the care they want during their entire course of treatment.
Four major challenges need to be overcome
While we have identified early successes in those three areas with the program, we have also encountered some obstacles and a steep learning curve in four areas:
- Practice transformation is not easy. Practices have a certain way of doing things, and it is challenging to justify major changes in the clinical work flow. For example, why is there even more clicking (documenting) in the EMR? Do the quality metrics really improve quality of care? Are program demands simply creating more work?
- Identifying patients who should be in the program is difficult, particularly those receiving oral drugs only. It is often hard to know which patients meet criteria for enrollment, particularly those on oral medication. Intravenous medications are administered within the walls of the clinic so it is easier to identify and enroll these patients in the OCM. Patients getting oral drugs often have to receive their medications from an outside pharmacy and this is difficult to track. To date, practices don’t have a good solution to capture patients prescribed oral drugs only.
- Submission of data is challenging. It still requires a lot of work. For most practices, this is probably their biggest challenge. Many EHR systems must be upgraded to be capable of collecting, reporting and submitting OCM performance data to Medicare and then be able to scale as the program adds new reporting requirements. Practices should work with their existing EHR vendors or talk to new EHR vendors to make this happen.
- There is uncertainty concerning hiring new staff. CMMI provides $160 per-beneficiary monthly for the delivery of enhanced services, which, in turn, means practices are expected to hire new staff to deliver these enhanced services. Practices are still trying to figure out what type of hires to make, how many people to hire and how best to optimize performance in these new positions.
Looking beyond the OCM’s first year
The OCM, a five-year project, will most likely last for the entire period. But the future beyond the OCM is still uncertain. Practice transformation takes time, so it will be several years before we even know if the model works. If this particular model demonstrates cost savings, something similar could serve as a more permanent method of reimbursement for cancer care. Future models are expected to move even further towards shifting risk to the practices and rewarding those who can manage risk. Whatever happens over the next few years, there will not be a return to full fee-for-service.
It’s unlikely the elements of the OCM will represent the ultimate method of reimbursement. Rather, it is more likely a stepping stone to future reimbursement models. So, at the least, the OCM is good “practice” to begin learning how to build an infrastructure that drives value and manages risk.
While implementing the OCM is difficult, it is important to realize the model is genuinely good for patient care. Patient feedback has been positive, as patients recognize and appreciate the extra attention they’re receiving within this model. It remains to be seen if the 190 practices can take on all the additional requirements, perform well and be rewarded for doing so. If so, patients and practices will come out ahead.
This post originally published on July 18, 2017 as on the US Oncology Network Blog.
Related: Learn about Studiomaca’s OCM solutions for oncology practices