How technology can help providers embrace two-sided risk in CMS's Enhancing Oncology Model

Value-based care models and arrangements keep evolving. With CMS preparing to upgrade its current value-based Oncology Care Model (OCM) to the Enhancing Oncology Model (EOM), cancer centers are keen for insights that can help them participate and be successful.

During a September Becker's Hospital Review webinar sponsored by Flatiron Health, a panel of oncology thought leaders discussed how joining the EOM program can impact organizations' bottom line and how data and analytics tools can aid in optimizing strategies. Panelists were:

  • Nina Chavez, vice president, customer experience, Flatiron
  • Christian G. Downs, executive director, Association of Community Cancer Centers (ACCC)
  • James Hamrick, MD, vice president, clinical oncology, Flatiron
  • Victoria Taiwo, interim program manager, value-based care, Yale Cancer Center in New Haven, Conn.

Three key takeaways were:

1. The Enhancing Oncology Model builds on the Oncology Care Model. CMS is phasing out OCM, which the agency launched in 2016 to improve care coordination while reducing Medicare fee-for-service spending and rewarding oncology providers through upside risk arrangements. EOM embodies a redesigned vision in that it will continue to cover Medicare patients but will encompass only seven high-acuity cancer types, add downside risk, collect information on social determinants of health (SDoH) and require participating sites to integrate electronic patient-reported outcomes (ePROs) into their EHRs by Year 3.

Mr. Downs said EOM is generating intense interest among community hospitals, some of which have experience with OCM, while others are considering value-based care for the first time. "Everyone's looking to see, 'Who's going to do it? Are you going to do it? Are you going to do it?' and asking, 'If I do this, is it achievable with all the other things I'm trying to do right now?'"

"I applaud sites that are considering this because it shows they have an appetite to continue to improve," Dr. Hamrick said.

2. Documentation and infrastructure will be key to success in EOM. The implication of the EOM requirement to collect ePROs is that participating providers will need the right capabilities to harness and document the data, as well as the right infrastructure to analyze it and understand how to pivot. Yale New Haven's Smilow Cancer Hospital, which is participating in an American Society of Clinical Oncology Medical Home Certification pilot, already collects ePROs on SDoH, distress and depression using iPads. "It gives us a step ahead on ensuring success in EOM," Ms. Taiwo said.

Another measure of success will be having a mechanism to enable continuity of care as patients step down from acute to post-acute or community care settings. Yet other success metrics are expected to carry over from OCM, including cost of care, readmissions rates, ED visits, types of drugs used (biosimilars/generics versus brand-name drugs) and duplication of labs and imaging tests. "Having the analytics to pull in all that information is key," Ms. Chavez said.

3. Data and analytics tools can give those cancer centers participating in EOM a leg up. Providers that wish to join EOM but are hesitant as to whether they can comply with the program's requirements, particularly requirements around reducing total cost of care, can avail themselves to tools such as Flatiron Assist. Flatiron Assist is a point-of-care decision-support tool that surfaces National Comprehensive Cancer Network guidelines and categories of preference, in combination with locally customized guidelines and clinical trial options, to help physicians make optimal treatment pathway decisions and therapeutic selection.

"You can't talk about putting cancer centers on the hook with downside risk on total cost of care without talking about drugs and therapeutic selection," Dr. Hamrick said, noting that drugs typically make up between 40 and 60 percent of total cancer care spend. "Doctors don't control drug pricing, but we are the ones who select the therapies that get used by our patients."


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