The US Oncology Network’s Stuart Staggs, MSIE: “Practices Need to Get Comfortable With Being Uncomfortable With 2-Sided Risk”

As community oncology practices weigh whether to sign on with the Enhancing Oncology Model (EOM) by July 1, Stuart Staggs, MSIE, senior director of strategic programs at McKesson, discussed the challenges that community practices face in making a decision on the EOM, as they also seek to advance health equity. Staggs also discussed changes within The US Oncology Network, which has grown in size the past year.¹

Staggs was a point person for the network of independent practices during the years of the Oncology Care Model (OCM), Medicare’s previous alternative payment model (APM) that ran from 2016 through 2022. He recently shared data through December 2021 that show savings to Medicare among the practices reached $337 million, when comparing total expenditures with expected benchmark costs.²

This interview with Evidence-Based Oncology (EBO) has been edited for length and clarity.

EBO: Can you describe the top challenge in community oncology and how you have addressed it through your role in The US Oncology Network?

Staggs: One of the biggest things with community oncology is continually trying to prove that we can provide higher-quality, sustainable outcomes at a better cost. Oncology as a whole, as an environment, is getting more complex. So how do we do that when we’re also looking at providing access to broader services and taking on potentially more burden with programs, when we’re trying to prove how we’re doing, submit data, look at data, and gain access to data?

With The [US Oncology] Network, what we try to do is simplify all that. We partner with practices and have practices partner with each other to share how…we, again, show that we’re higher quality. [How do we] prove that we can provide better outcomes at a more sustainable cost through best practices, through technology adoption, through leveraging data for action, and try to really balance that equation with the cost equation?

…We know oncology costs are large—and how do we bend that cost curve? We’re trying to really put it out through payer partnerships, employer partnerships, and through nonregulatory programs like the OCM, the upcoming EOM, and even through core programs like MIPS—Merit-Based Incentive Payment System—and MIPS Value Pathways [MVPs].³ So [there are] a lot more acronyms in the fold now with the government.

EBO: How has the end of the OCM changed the dynamic between public and commercial payers in advancing APMs in cancer care?

Staggs: It has been an interesting journey with the OCM over the last 6 years. With our network, we felt like we accomplished a lot; we did a lot of new things to improve access to services for our patients, with social work navigation to more targeted services around psychosocial [services], even deeper financial counseling. We achieved a lot on the patient access front and on the experience front. On the quality pieces, too, we reduced hospitalizations, reduced the need for visits when they weren’t appropriate, and we also increased access to end-of-life support for patients and their families. So we saw a lot of good outcomes on the quality front, and also bent the cost curve. When we tallied it up at the end of 6 years, compared [with the] benchmark, which is a prospective cost from CMMI [Center for Medicare and Medicaid Innovation], we [had] saved around $337 million to Medicare against that benchmark across the network.

Obviously, there are some things that need to change with the program to make the next version with the EOM more viable and more balanced. But from a private partner standpoint, we saw a lot of momentum with commercial payers, too; not totally mimicking the OCM, but a lot of the same quality measures, a lot of the same expectations, a lot of the things that we were trying that were new and different around performance-based outcomes. And there’s a lot more engagement with commercial payers and more alignment. I think alignment is key, because if we’re all focused on a shorter list of things we want to improve on, we can actually improve those things a lot more effectively. We did see a lot of momentum on that front, and also with employers, too. [We’re] starting to see a lot more traction, more employee opportunities even more recently. It’s interesting, though, with CMS and CMMI; they are tackling oncology from a lot of different angles. You also had the Advancing Cancer Care model that was introduced this year through MVPs, so we’re trying to figure out that balance between tackling kind of an oncology version of MIPS, in tandem with looking at models like the EOM. It’s…an interesting environment right now, even just on the regulatory front.

EBO: There has been a lot of discussion about advancing health equity. In your opinion, what is the best way for a community practice to do this?

Staggs: I think we’re all focused on similar things right now around equity and access. We all want to collectively learn where the opportunities are, and you’ll see that within CMS, too. We’re in a learning phase; we’re trying to gather more information around where pockets of disparity or unequal access are by collecting more data around sociodemographics. We’re trying to ask and assess more around social needs, also some of those social barriers…. There are too many opportunities out there, so it’s [a matter of] how do we prioritize them and meet the needs of our patients, and meet them where they are, and create more community access on top of that? We have practices, obviously, that are very engaged in their communities. But how do we even do that more broadly? On top of that, how do you get access to more community resources?

We have seen in the last 2 or 3 years here that community resources have become more challenging to gain access to, or some do not exist] anymore since COVID-19, and other bigger things have happened. So that’s…the balance we’re trying to find right now as we are continuing to assess patients more around social needs, using the [National Comprehensive Cancer Network] Distress Thermometer,⁴ and trying to explore more around areas where we have disparate access. The next step is how do we take action on all that? We are looking at, on the social needs front, a national partner to really look at how we close the loop on food insecurity, housing, transportation, and those broad needs within that Distress Thermometer as a starting point. There’s a lot we need to tackle and learn along the way. I think it’s early in the process, and it’s something that has really been a need for a long time that I’m glad is getting the attention it needs.

EBO: The US Oncology Network has added several new practices in recent months, including Regional Cancer Care Associates on the East Coast. Why is network participation picking up speed?

Staggs: To the earlier points, oncology and community oncology are becoming even more complex, and cost is…out there, it’s expensive. From a community oncology practice standpoint, they really look at the network. And they say, “Okay, we have goals we want to achieve, we have a desired future state we want to get to, so how do we partner to do that?” And they’re looking at partners like The US Oncology Network as a way to achieve that. You look at our experience, our knowledge, our access to capital within the network. It’s really attractive for them to say that we’ll get to that next level of achieving our goals as a practice, and staying out in our communities, and also be competitive against noncommunity sources of care.

[Practices] also look at how we handle best-in-class drug pricing, payer support, [and] value-based care support like my team delivers; [they are] also looking at a world-class revenue cycle. We are trying to make sure we’re able to take a lot of that burden and a lot of those stressors off the practice so they can focus on delivering that high quality care to their patients. Of course, The US Oncology Network is affiliated and part of the larger McKesson corporation, so they’re very focused and dedicated to delivering on oncology and meeting the needs in that arena, so that also helps.

EBO: What should practices know about the relationship between The US Oncology Network and Sarah Cannon Research Institute?

Staggs: We’re very excited about this partnership. With this, the network has a chance to really expand its access to clinical trials, and not just trials as a whole, but really early-stage, late-stage, both ends of the spectrum there. It also provides greater support for physicians to get involved in actually conducting trials and being part of those studies. We have a big focus on personalized medicine and in really enhancing our research footprint. This is a natural pairing with Sarah Cannon, and we’re really excited about all those aspects of that relationship. It is pretty new, [and we still have to] figure some things out, but it’s a lot of opportunity there, which is great.

EBO: Practices will soon have to decide whether to pursue the EOM. What are the most important considerations for practice leaders?

Staggs: The landscape is getting pretty involved and pretty thick with programs, which is great. We have a lot of motivation within value-based care to do things differently. With the EOM, the big focal point with practices is to say, “Where do we want to be in 5 years?” because again, it’s another 5-year voluntary program, like the OCM with Medicare, and “Do the tenants of the program really align with where you want to land 5 years from now?”

Like we talked about earlier, there’s a bigger focus on health equity and social needs as part of the redesigned activities within the EOM. If some practices don’t go that direction, we’re still going to want to focus on that; that’s not going to make a difference, we’re still going to focus on those needs, and our practices are right there with those priorities. But again, that’s part of the model also—how to participate in the model and meeting those requirements within the EOM to align with those goals around equity and social needs. It is focused more on 7 diagnoses instead of around 20 that were part of the OCM, which makes sense in ways; it also makes it more challenging in ways. It makes sense in the manner that it focuses on diagnoses that are higher volume, higher cost, higher complexity, and on patients that are in our practices a lot more, so we can do a lot more to really affect the quality and their experience and their access to services and the total cost on top of that.

At the same time, it also creates some challenges because, with fewer patients in the program, there are fewer episodes, there’s less funding; the amount of funding with the monthly enhanced oncology service payments is going down. So there are less obvious ways to invest dollars, invest in resources, and then be guaranteed a return. It’s that balance between making that different investment, obviously having to perform to earn that back, and then really seeing positive results, because within EOM day 1, come July 1, it’s going to be a dual-sided risk model. Practices need to get comfortable with being uncomfortable when it comes to 2-sided risk. That’s what we always talk to the practices about. We want you to be confident in engaging in this model and what you want to achieve over the next 5 years. At the same time, you’re going to be uncomfortable, and that’s part of 2-sided risk: They want you to be uncomfortable to the point where you’re going to do more than you would otherwise and achieve better results for your patients and your practice and for the program.

And practices are looking at data. We have an actionable analytics team that really digs a lot into the data to show how they would have done, how they could do, what their level of exposure is, [and] what their opportunities are. [Practices are] making that informed decision with confidence, and then we’re with them for the next 5 years to make sure they get the results they expect. But we also expect them to be uncomfortable, so they just have to get used to that.

References

1. Regional Cancer Care Associates joins The US Oncology Network. News release. The US Oncology Network. April 6, 2023. Accessed May 9, 2023. https://bit.ly/3M5A1W9
2. Caffrey M. Amid concerns, will practices take part in the Enhancing Oncology Model? Am J Manag Care. 2023;29(spec no 4):SP328.
3. Crum E. Clinicians and payers expect to wait and see before embracing CMS MIPS Value Pathways. Am J Manag Care. 2021;27(spec no 6):SP245-SP246. doi:10.37765/ajmc.2021.88735
4. National Comprehensive Cancer Network. NCCN guidelines version 2.2023: distress management. Updated December 22, 2022. Accessed May 9, 2023. https://bit.ly/3HSxLPA