Dr Michael Kolodziej Discusses Taking on 2-Sided Risk in OCM After PP4 Results

Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc., discusses the move to 2-sided risk in the Oncology Care Model (OCM).

Transcript

We're at a transformative time now with the OCM, with performance period 4 results out now with some practices having to either take on 2-sided risk or leave the model. What's the mindset of these practices right now?

You’d have to ask them. So, in general, I think physicians are risk averse. I think it’s pretty clear, and this is based on what [Center for Medicare and Medicaid Innovation] has told us, that a quarter of the practices aren’t close. Those guys are just going to quit. I think for the 35% or so of practices that are on the cusp, the question becomes if you do the math: I get the [Monthly Enhanced Oncology Services], I get the 5% bonus because of the advanced [alternative payment model], how far away am I and how can I manage that risk? And at least the scuttlebutt is that a lot of practices are engaging insurers to protect them from catastrophic loss.

So, they’re buying insurance against a bad outcome, which is not a bad idea because of the fact that we don’t know what therapies are going to come out in the next 5 years. We don’t know what the case mix is likely going to be in the next 5 years, and those are variables we cannot control. So even if you’ve done splendidly until this point, there’s still going to be risk going forward.