Improving Care with the Oncology Care Model

Susie BaficoOncology Care Model, Value-based Care

A recent blog from the American Journal of Managed Care called “Lessons From the Field: How Practices Are Succeeding Under OCM,” recapped a discussion from NCCN’s policy summit with 2 organizations working to succeed in the Oncology Care Model (OCM). OCM practices are tasked with a transformation to a value-based model defined by improving patient care, reducing costs, and lowering utilization. And while the costs of cancer treatments have been increasing without a clear measure of increased efficacy, one-third of OCM practices have lowered their costs and achieved savings through the model. 

Kerin Adelson and Diana Verrilli shared anecdotes from their organizations, Smilow Cancer Hospital and the US Oncology Network, respectively, and described how their organization is handling the OCM 3 years after it launched.

Smilow Cancer Hospital

Adelson stated that while the cost of cancer drugs has increased, from 53% of the total cost of care to 60% in period 3 of the OCM, Smilow came up with a plan of action. The organization focused on the 40% share of non-drug costs, since they cannot control the cost of drugs. They built a care management program designed to help providers better manage utilization patterns, such as emergency department visits. When comparing years 2012-2015 (before OCM) with the first 3 performance periods of the OCM, the total cost of care rose for Smilow Cancer Hospital, but it was less than CMS predicted so they achieved savings. Overall Smilow has received performance-based payments of over $6 million.

US Oncology Network (USON)

Verrilli mentioned that USON practices focused primarily on reducing utilization, but allowed practices to target areas where they saw a large variation in utilization. For example, a practice noticed variation in supportive care drugs, so they were able to introduce and implement appropriate use policies to manage utilization. USON noted that they have 15 practices participating in the OCM, and Iin performance period 4, 14 practices fell below the benchmark and 5 have received performance-based payments. Notably, over a 2-year period of the OCM, the USON practices achieved $36M in Medicare savings and $89M total.

Challenges ahead

Both Adelson and Verrilli recognized the challenges their organizations face with the OCM in general and with getting physicians to change their behavior in a value-based care environment. There was a consensus that data is the most compelling way to drive new behaviors and reinforce positive ones with physicians.

Two approaches to engage physicians were:

  • Providing data quarterly and setting utilization goals
  • Using clinical pathways at point of care to ensure oncologists have the tools they need to treat and consult with any patient

Other challenges mentioned included conducting a successful practice transformation rollout, identifying and enrolling the right patients, setting up the EHR system properly to capture quality measure data, and clearly define new roles required, such as patient navigators.

Navigating Cancer can help with OCM reporting

Participating in the OCM can completely shift how care is delivered in a practice as succeeding in value-based care requires transformation. At Navigating Cancer, our comprehensive patient relationship management platform helps practices manage their reporting for the OCM as well as other value-based care agreements. Want to learn more about how we can help you transform your practice? Contact us for a demo today!