Early Key Findings in OCM

As we are looking at the data, we have identified a few areas of focus for OCM practices. Read on for Archway’s early key findings in OCM. Selected Findings – Cancer Types

When looking at different cancer types, the question for OCM practices should be: Where do I focus first? By analyzing the data, you can identify the cancer types that you want to focus a greater effort on improving, and the types that you’re handling well already. The method we use is to extract all episodes for a given cancer type, compute the difference between price and cost, and calculate mean gain/loss and percent winning.

The goal should be to focus on areas with the most room for improvement. This way you can prioritize to achieve the greatest improvement for the least effort. You should also take a look at which cancer types may be the outliers for your practice. You could even drill down to the episode level and find out the patient names for those outlier cases. By understanding what happened in those episodes, you can take steps to potentially avoid similar cases in the future.

Selected Findings – Pricing

In the past, providers were accustomed to billing for everything. In value-based payment, however, providers get credit for the complexity of the patients. That’s why it’s so important to accurately and completely describe patients. Some drivers of target prices are clinical trials, Hospital Referral Region, and clean period which is the number of days from the episode start date to the last day on which the patient received chemotherapy.

Selected Findings – Inpatient and ER Use

We analyze what happens when a patient visits the ER and is either sent home or admitted. There is a $6,500 per patient difference when the patient goes to an inpatient bed instead of home. What is important is not just keeping patients out of the ER, but managing the patients once they are admitted to the ER. Our data only shows patients that showed up at the ER and had a claim line initiated when they presented themselves there.

One action item based on these findings would be to use the data to investigate ER admit rates. The variation is real. This can be a quick big hit for oncology practices.

Selected Findings – Drugs

Some of our initial findings on drugs were surprising. What stands out is that some drugs have more inpatient cost than others.

Practices can expect to see some seasonality in drug costs. Episodes that start in the second half of the year are going to have two Part D limits, and that’s going to have an effect. Practices will fare better in reconciliation with the episodes that start in July – December than they will with episodes from the first half of the year, because the later episodes have the advantage of falling under two separate reconciliation periods.

Is your practice preparing for OCM? Please contact us at info@archwayha.com to learn more about how Archway Health can help your practice succeed in OCM.