Robert “Bo” Gamble
The thought of joining the Oncology Care Model (OCM) didn’t scare Tracey F. Weisberg, MD. She had participated in the Community Oncology Medical Home (COME HOME) program, an earlier model of patient-centered care, so OCM seemed like a natural next step for her practice, New England Cancer Specialists of Scarborough, Maine. Both programs aimed to focus practices on payment based on value of care provided rather than volume of treatment. After adopting strategies to increase the value of care at New England Cancer Specialists through COME HOME, Weisberg considered her practice ready for the OCM, and she greeted the pilot value-based payment model with optimism.
"The idea was a natural for us coming out of COME HOME. It built upon the expectation of quality and value that we had already instilled in our staff and patients, so it was a natural process for us," Weisberg, said.
In the words of a recent Tuple Health study on OCM enrollees, Weisberg’s practice would be considered a “high-expectations participant.” The study, commissioned by the Community Oncology Alliance (COA), is the first to analyze the reasons 187 practices have chosen to participate in the OCM.1
Study authors Celeste Roschuni, PhD, MS, and Basit Chaudhry, MD, PhD, of the healthcare technology startup Tuple Health in Washington DC, identified 4 types of participants: dubious, reluctant, high-expectations, and pathway.
“The Tuple Health study helped us realize that a successful reform model will need to appeal to all 4 types of OCM enrollee,” said Robert "Bo" Gamble, BS, COA’s director of Strategic Practice Initiatives. “Each gravitates to a certain type of communication.” Therefore, the OCM’s administrator, the Center for Medicare & Medicaid Innovation (CMMI), must focus on communicating effectively with OCM participants for the 3-year pilot payment model to be successful, Gamble said.
The goal of the OCM is to incentivize high-quality, coordinated care with an episode-based payment model that emphasizes patient access and navigation (FIGURE). Practices receive monthly per-patient payments to cover the high-touch elements of this form of care and additional costs involved in elevating quality. There are 6 major requirements (TABLE).
Figure. Key Components of Oncology Care Model
However, physicians and practice administrators have stated that succeeding with the OCM has been a challenging mixture of technological difficulty and cultural adaptation. Although some say that it has worked out for them, others doubt that it can succeed for all practices. At the same time, groups such as the American Society of Clinical Oncology and COA have lobbied for collaborative models of care that are better tailored to oncology practice and include more input from oncologists themselves.
CMMI, the experimental arm of CMS, started the OCM in July 2016 with 195 practices and 17 payers enrolled as participants. By mid-February 2018, those numbers had dropped 4% and 1.7%, respectively, to 187 and 14.2
“They’re expecting to change the way healthcare’s been delivered for the past 52 years,” Gamble said. “They can’t do that if they’re not thoughtful and careful and cautious in helping people make this transformation in their thought process.”
Table. Requirements for Participation in the OCM1
The 4 Types of Participant
By analyzing 35 responses to a survey they conducted, Chaudhry, Tuple Health’s CEO, and Roschuni, the startup’s lead researcher and study designer, identified 4 OCM participant types. Practice members’ mind-sets ranged from doubtful to eager, the duo found. It’s important to understand these states of mind, Roschuni said, because “each one will have a different path [of success] to value-based care.” From dubious to pathway (forward-thinking), the predominant attitudes represented “the least engaged to the most happy,” Chaudhry said.
Dubious participants came to the OCM with no prior experience in value-based care programs. Their loyalties lie with the fee-for-service model, which rewards volume of care, but they see the transition to value-based care as inevitable and don’t want to “be left out in the cold,” as one practice told a Tuple Health interviewer.