The Oncology Care Model and Two-Sided Risk: Make an Informed Decision

The Oncology Care Model and Two-Sided Risk: Make an Informed Decision

For the 175 practices participating in OCM, reconciliation reports are the moment of truth for each performance period in value-based payment programs. These reports reveal whether or not providers have beat their target prices and earned a Performance-Based Payment (PBP). But, PP4 isn’t all about the potential to bring in more revenue. Participants’ PP4 performance will bear much weight in determining whether they will be required to take downside risk to remain in the program moving forward. 

Reflecting on ACCC: Commercial Bundle Contracting for Cancer Care

Archway’s chief analytics officer, Mah-J Soobader, PhD,  recently presented at the Association of Community Cancer Centers (ACCC) 44th Annual Meeting and Cancer Center Business Summit in Washington D.C. Each year, the event brings together hundreds of cancer care professionals and thought leaders to explore innovative approaches for navigating the biggest challenges and opportunities in oncology.

As rising healthcare costs have caused industry-wide concern, an opportunity that has been brought to the forefront is developing better ways to pay for cancer care. Dr. Soobader spoke on a policy panel at ACCC, “Preparing for Commercial Bundles in Oncology.” The panel offered insights on successful strategies to simultaneously reduce the cost and improve the quality of cancer care.

Dr. Soobader provided a window into Archway’s process in collaborating with organizations to build successful commercial bundled payment programs. The major takeaway from Dr. Soobader’s presentation is that a clinically-informed, data-driven episode is the key to building an accurate, fair and profitable bundled payment program. Archway helps healthcare organizations gather their performance data and data of peers to determine where the opportunities lie for more efficient care. In finding and testing areas for improvement, providers are then able to negotiate their prices with payors. 

For providers interested in building commercial bundle programs, Dr. Soobader advised, “The pathway to commercial is experimenting in Medicare programs, and experimenting successfully.” In other words, Archway recommends providers participate in either the Oncology Care Model (OCM) or Bundled Payments for Care Improvement (BPCI) Advanced Initiative to determine what works with some guidance from CMS before striking out on their own. Based on experience, Dr. Soobader recommends this approach as a way for organizations to identify key strategies required to be successful in bundled payment programs.

Whether you start with Medicare bundles or are developing your own commercial programs, data-driven insights will be the key to healthcare improvement and financial success in bundled payments. Talk to us about receiving and analyzing your own data to analyze your opportunity in bundles.

Asking the Right Questions to Achieve Success with OCM

At the recent Association of Community Cancer Centers (ACCC) National Oncology Conference in Nashville and the Community Oncology Alliance (COA) Payer Exchange Summit in Virginia, participants in the Centers for Medicare and Medicaid Services (CMS) Oncology Care Model (OCM) discussed the challenges of implementing such a program. Changes have significantly impacted practices’ organizational culture and staffing, among other areas. Since CMS announced the launch of OCM in 2015, oncology care practices have been working to implement and manage bundled payments to learn how to be more efficient and effective providers. While there has been significant learning along the way, some providers have just started discovering their performance. While challenges still remain, we feel that this voluntary OCM bundled payment program is a step in the right direction.

At Archway, we have identified key questions that we recommend all OCM participants consider to determine what is needed to transform their organization:

-       How is my organization currently doing? What are my organization’s performance goals compared to our target expenditures?

-       What are the key drivers of my organization’s performance? How does my organization compare to other practices?

-       What can we change? What are the key drivers of savings and controlling costs? Where is there room for improvement?

Asking these questions is challenging. And some oncology care specialists will see this as a wakeup call as they realize they have limited data and analytics to provide answers. However, practices that operate without knowledge of their results are working blindly. And, the real answers to these questions will lead you to better care and increased savings.

By participating in the OCM bundled payment program, practices can realize opportunities for reducing cost of care and improving care delivery. Claims data is only valuable once it is transformed into actionable insights. To help OCM practices meaningfully analyze this data and manage a successful program, Archway has developed a proprietary online Oncology Care Analytics Suite™ platform. We help organizations tap into deep analytics to better understand performance results based on quarterly costs and trends, spending and claims details and more. Our SaaS-based tool is designed to evaluate and analyze the raw quarterly data delivered by CMS to help oncologists discover how their practice is performing on a clinical and financial level.

Oncology care practices that are participating in OCM are already on their way to achieving the significant impact of understanding the results of value-based payment initiatives. What is your practice waiting for?

Contact us for more information about how we can help your organization answer the three key questions above.

Specialist Engagement is the Key to Bundled Payment Success

In the last 6 years or so, bundled payment activity has picked up tremendously with the Centers for Medicare & Medicaid Services (CMS) both mandating and offering several programs aimed to help providers achieve efficiencies in care. We're encouraged that in a recent article, Modern Healthcare picked up on the success that providers are experiencing within the CMS’s Comprehensive Care for Joint Replacement, or CJR, and Bundled Payments for Care Improvement, or BPCI, programs. While the success highlighted in the article focused on orthopedics and procedural care, both Medicare data and our experience demonstrate that this success has also included significant improvements in quality and cost in chronic conditions like CHF and COPD, even in cancer care with Medicare's Oncology Care Model, or OCM, program.

The key to success has not been what is bundled, but rather who is bundling. A deep look into the data reveals that programs in which specialists are deeply involved have had the most success in both improving care, cutting costs and achieve efficiencies.

Having worked with BPCI, CJR, and OCM participants since the inception of these programs, we have learned that there are four keys to unlocking this level of success with bundled payments programs. And, these work within almost any high-cost, complex acute or chronic condition:

  1. Put the specialists in charge of the process.

Medicare data of BPCI bundles reveal that specialists are well-positioned for leadership and of bundled payment initiatives. In programs with strong specialist leadership and alignment, we have seen costs reduced by more than 14%, where as hospital-driven bundles without specialist engagement saw savings of just 4%.  In addition to lowering costs, specialist led programs achieved greater decreases in length of stay and declines in skilled nursing facility utilization.

  1. Engage high-volume specialists in critical clinical areas, like orthopedics, cardiology, pulmonology, and oncology.

Orthopedic specialists have gotten a lot of attention in bundled payments with the CJR program. But, with potential cuts to the CJR program, the success of voluntary models can fill the void in a more participatory, rather than mandated way. Additionally, other high-volume specialists should be a major focus, and not avoided.  Complex patients who have historically used lots of resources are also generally have significant variability in costs and outcomes, these patient populations present the best opportunities for improving the process and achieving better results.

  1. Give the specialists the full data sets.

A major factor in any bundled payment success is data. Specialists have to be able to see not only their own, but also data from the full continuum and their peers, to gain a full understanding of where the costs go and what happens to the patients over the course of a complete episode of care. This helps specialists identify the path to improvement for the patients they care for.

  1. Encourage specialists to innovate around the best way to care for their patients across the full continuum of care.

Once specialists are participating in bundled payment contracts and examining the data, in our experience, they begin to innovate all kinds of new and improved ways to care for their patients.

When all four of these elements are at play, we see tremendous improvements in the process, outcomes, the patient experience, and costs start to come down dramatically.

While some were disappointed that the CMS recently scaled back the mandatory programs, the agency has also repeatedly indicated that it will be implementing the next generation of the voluntary BPCI program soon.

Given this continuation and the physician-focused language in the latest RFI concerning CMMI’s “new direction,” we expect the new program to provide even more of an opportunity for specialists—even high-performing ones—to participate in and benefit from value-based payment reform. With the success of the original BPCI programs, CJR and OCM, we expect to see significant demand among specialty physicians and their hospital partners  in the upcoming program.

Oncologists Flock to Bundled Payments in Unanticipated Numbers: 4 Key Notes

Becker’s ASC Review covered the announcement from a recent Archway Health press release in their short write-up, “Oncologists flock to bundled payments in unanticipated numbers: 4 key notes.” The post quotes Dennis Zoet, senior director of business development and operations for Kalamazoo-based Western Michigan's cancer and hemotology centers: "Our institution has always sought new ways to improve patient care, while reducing costs. The OCM model allows us to do just that within our population of patients battling cancer. Given the breadth and depth of their experience within bundled payments, Archway Health is an ideal partner to help us navigate and succeed within this new landscape.”

Read the full Becker’s ASC Review post here: http://www.beckersasc.com/asc-coding-billing-and-collections/oncologists-flock-to-bundled-payments-in-unanticipated-numbers-4-key-notes.html

Read the original Archway Health press release here: http://www.businesswire.com/news/home/20170202005781/en/