A Payer's Takeaways on the OCM

Published: Friday, Nov 24, 2017
 Peter Aran, MD

Peter Aran, MD

OBMTM: Please explain your role as a private payer in the OCM.

Aran: Several years ago, CMS made a few wise decisions. One of those was creating the OCM—a multipayer initiative aimed at transforming care delivery. We do need to improve healthcare in the United States this way, so that doctors don’t have to do one thing for Aetna, one thing for Blue Cross, and one thing for CMS. The goals must be aligned.

When I went to medical school, the care team might have included the nurses, the pharmacists, and maybe the social services staff, nutritionists, and doctors, and now we’ve expanded some 20 to 30 years later to include even the people in the community and the payers as part of the expanded care team.

Is Blue Cross Blue Shield mirroring the payments and incentives that CMS has mapped out for practices in the OCM, such as the monthly 0 care management payments?

Aran: One of the responsibilities of payers was to outline a payment system roughly similar to the payment structure of CMS. And we did that. We have the care management fees defined by CMS that are known as monthly enhanced oncology services (MEOS) payments. We also have a payment at the end of the care cycle that is based on quality measures and patient and family satisfaction. That’s our own combination. We have a slightly different point of view from CMS regarding how the payment formula should be developed. We put more emphasis on what happens a year later by using measures of quality, such as patient and family satisfaction.

Our plan also includes a shared savings component that we think is more important for the financial viability of the practice than the MEOS care management fee. The reason we think that is because of our experience with another CMS Center for Medicare & Medicaid Innovation (CMMI) program, the Comprehensive Primary Care initiative, which was designed to strengthen primary care by offering care management fees and shared savings opportunities. That program ended on December 31, 2016, and has been followed up with Comprehensive Primary Care Plus.

What are your takeaways on the value of the OCM at this point in the pilot?

Aran: The biggest takeaway is that this gives our patients access to care and, on the back end, payers pay nurses and pharmacies and doctors for the care received.
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