What Will Oncology Care Model 2.0 Look Like?

Nov. 22, 2019

CMMI seeking input on 'Oncology Care First Model' that would include total cost of care accountability

The 175 oncology groups still participating in the Oncology Care Model of value-based payment have been eager to know what the Centers for Medicare & Medicaid Services plans to do for a follow-up act when the model expires in 2021.

In early November the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation provided an answer when they published a Request for Information about what they call the “Oncology Care First Model (OCF)” and gave people only a few weeks to respond. After some grumbling from stakeholders they extended the deadline until Dec. 13.

Several groups had submitted oncology-related proposals to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), but none of the PTAC recommendations has been approved by the Secretary of HHS. The RFI says, “We are continuing to think of ways to incorporate elements of these proposals submitted to the PTAC as well as PTAC’s recommendations and comments.”

Noting that the new model would build on lessons learned in the Oncology Care Model, CMMI said it would test “whether an innovative approach to prospectively paying for management and drug administration services provided by oncology practitioners, together with a total cost of care accountability, reduces program expenditures while preserving or enhancing the quality of care for Medicare beneficiaries with cancer or a cancer-related diagnosis. The multi-payer aspect of this potential model could also encourage more comprehensive oncology practice transformation and provide the opportunity to improve the quality of care and decrease costs for non-Medicare fee-for-service oncology patients.”

As envisioned, OCF would include both physician group practices and hospital outpatient departments that provide oncology care. The model would be designed to align participants’ financial incentives to eliminate reliance on volume-driven, fee-for-service revenue cycle management while increasing accountability for outcomes in oncology care. The model would test whether holding participants accountable for total cost of care and offering them predictable revenue streams through an alternative payment mechanism improves care coordination and management for Medicare beneficiaries with cancer or a cancer-related diagnosis while reducing expenditures under the Medicare program.

In response to the RFI, the American Society of Clinical Oncology (ASCO) released an update to its Patient-Centered Oncology Payment (PCOP) model. The updated model reflects lessons learned from previous demonstration programs, including a PCOP pilot in New Mexico, ASCO said.

ASCO said its model addresses an array of pressures facing cancer care, including the growing financial burden on patients and families and increasing administrative burdens on practices as a result of expanding utilization management requirements.

The organization said the PCOP update uses an oncology medical home framework, which has shown improved outcomes and reduced costs; a performance-based reimbursement system that relies on patient-centered standards and transitions to bundled payments; and consistent delivery of high-quality care using clinical pathways that adhere to ASCO criteria.

Modeling all-payer data from the Maine Health Data Organization, ASCO has projected significant potential for PCOP to yield cost savings--up to 8 percent across the healthcare system.

Also in response to the RFI, Ethan Basch, M.D., the Richard M. Goldberg Distinguished Professor in Medical Oncology and director of the Cancer Outcomes Research Program at the Linebarger Comprehensive Cancer Center at the University of North Carolina, tweeted: “Kudos to CMMI for championing patient-centered cancer care by including patient-reported outcomes as a key tenet in their draft plan for the Oncology Care First Model, to succeed the OCM.”