Challenges and Opportunities in the Oncology Care Model

The practices that have been participating in CMS’ Oncology Care Model (OCM) have undergone significant practice transformation in order to be successful in the program. However, even after being in the model for 2 years, there are still remaining opportunities for investment.

According to Charles Saunders, chief executive officer of Integra Connect, most practices have spent the first and second year of the program just “getting up to speed.” They were learning how to manage under the new model. As a result, he believes there is still room to go in implementing some of the traditional changes needed, such as managing office hours and emergency department visits, as well as risk stratifying practices’ populations and managing transitions in care.

Saunders also highlighted that there was plenty of work left to do in end-of-life care.

“There’s a lot of room to go in end of life because of the percentage of patients who meet the OCM-3 target goal for hospice is incredibly low for the population,” Saunders said, referring to the measure for the proportion of patients who died who were admitted to hospice for 3 days or more.

But there are also things about the program that need to change, according to Saunders.

“I think the OCM program needs to evolve so that the target setting is more accurate and effects reality better, that the attribution logic is addressed, and that drug costs and so forth are appropriately addressed and there are proper incentives in place,” he said.

Marcus Neubauer, MD, chief medical officer of The US Oncology Network, added that reporting data to CMS can be very cumbersome for practices. While practices participating in OCM benefit from receiving claim data that practices don’t normally receive from payers, practices have to enter data on each individual patient and report on all of them.

Another challenge that Neubauer mentioned were drug expenses. OCM was designed around expenses incurred over a 6-month period, and during that period, drugs are “by far and away the largest expense.” The problem is that there is not a lot of leeway on managing drugs.

“If a patient has an advanced cancer, they’re more than likely going to benefit from at least trying an immunotherapy,” Neubauer explained. “We can’t leave those out, and yet, those drugs are very expensive. So, it’s a challenge to try to lower the cost of care knowing that the drugs are very expensive, and we don’t really have a lot of cheaper alternatives to choose from.”

Eventually practices are expected to move into a 2-sided risk model, but Saunders expects them to be reluctant to do so if they haven’t been able to control costs and generate savings.

Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc, once might have said that no practices would choose to take on 2-sided risk, but it has become apparent that some will.

“But they’re the minority,” he said. “And we already know that the practices participating in the OCM are highly selected. So, the concept that this model will be rolled out to everybody and everybody will take 2-sided risk in the model is I think just ridiculous, if you want to know the truth.”