Value-based care is a much-discussed concept in the context of oncology, and the paper goals of the value-based model—improving the patient experience and minimizing extra procedures and costs—are Consistent with the goals of most oncologists. But developing the best model for all stakeholders is no small feat.
This was part of a panel discussion at the Association of Regional Cancer Centers (ACCC) 2023 Annual Meeting and Cancer Center Business Summit, including members of the ACCC Alternative Payments Coalition (APMC) and representatives from the Center for Medicare and Medicaid Innovation (CMMI). was the foundation. ) Within CMS, we will talk about value-based care and the new Enhancing Oncology Model (EOM), a value-based model launching in July.
The panel included APMC member Jeff Hunnicutt, CEO of Hylands Oncology Group, Pennsylvania. Mark Liu, MHA, Senior Director of Oncology Strategy, Transformation, and Analytics at Mount Sinai Health System and Tissue Cancer Institute in New York City. Anne Marie Rainey, MSN, RN, CHC, Head of Compliance and Quality Control, Clearview Cancer Institute, Alabama. Barry Russo, MHA, CEO of The Center for Cancer and Blood Disorders in Fort Worth, Texas.
Dr. Alexandra Chong, CMMI Analyst, EOM Policy Lead. Dr. Elizabeth Ela, Social Science Research Analyst at CMMI and she is responsible for EOM payments, also joined the discussion.
This session began with high-level lessons learned from the Oncology Model of Care (OCM), a value-based model of oncology care that began on July 1, 2016 and ran until June 30, 2022 . We focus on providing quality care while avoiding unnecessary procedures and costs.
Away from typical Medicare service fee (FFS) reimbursement, OCM was performed on the basis of 6-month “episodes” triggered by initiation of treatment such as chemotherapy. During these episodes, OCM participants ensured that the patient had 24/7 access to the clinician, that they used certified electronic health record (EHR) technology, and that data was collected and delivered to the caregiver. Continuously improve quality. The OCM practice was also required to use therapies in line with national clinical guidelines, provide patient navigation services, and complete care management plans from the National Academy of Medicine.
“I think we learned a lot from OCM,” says Rainey. “And it informs a lot of other programs that are going on right now. Of course, it informs what happens with EOM.” We emphasized that access, the use of data for continuous improvement, is an area of benefit for patient experience and healthcare providers. Proper use of pathways and patient navigation is also important, she noted.
Scheduled to launch on July 1, 2023, EOM shares some components and themes, but there are key differences that cause concern among panelists.
“There is a lot of critical infrastructure that many of us who attended OCM have put together in our practice. [to the] EOM…basically the infrastructure is transformed, but the program itself is very different. At least that’s our perception,” Russo said.
One big difference is the scope of the models. EOM does not cover all cancer types, but only seven types: lymphoma, chronic lymphocytic leukemia, multiple myeloma, and breast, lung, colorectal, and prostate cancer. is. An episode begins with treatment and an evaluation and management visit and lasts for 6 months. The patient will be attributed to the physician on the basis that she will be responsible for at least 23% of the assessment and management visits as well as the first visit after starting treatment.
With EOM, claims are paid through the FFS and then settled based on the cost of treatment by disease, with adjustments and decisions on whether providers should reimburse or receive performance-based payments . Pricing benchmarks are stratified by cancer type and determined with a regression model that considers national data on average spending, Ela said.
One issue of note to oncologists is the reduction in MEOS volume in EOM, which is lower than in OCM. MEOS payments are $70 per month per beneficiary plus $30 per month per beneficiary for dual eligible Medicare or Medicaid patients. Barry said it will be important to proactively identify and apply for dual entitlement cases.
“Perhaps the adjustment to MEOS is really the first thing that jumps out for me. And being quality focused (what we learned at OCM) is all good and we want to continue these things,” Hunnicutt said. “Well, with his MEOS on OCM, he could at least pay for those costs.” EOM’s reduction in MEOS may not give practice the same opportunities, he said.
EOM also puts practice and providers at risk. This is exacerbated by the declining number of eligible patients under EOM. All panel members noted fewer monthly cases under EOM. One potential solution Russo put forward is pooling with other practices, but he noted that there are additional regulations and challenges to keep in mind.
“Where healthcare is now financially, are we in a position to take a risk? ‘It’s hard to convince people to say,’ says Liu. He also said that against siled targets by cancer type, having a single pool for all patients would help him with OCM, and how EOM’s disease-specific targets would be useful to providers. said he didn’t know yet if it would help.
On the part of the panelists, all are undecided about attending EOM. Ultimately, EOM is voluntary and individual practices should consider their data and options. CMS indicates that the practice receives data from her OCM prior to her EOM, which adds practice-collected data that could be analyzed by those who attended OCM.
