NASHVILLE, Tenn: OneOncology leaders -- Aaron Lyss, MBA and Stephen Schleicher, MD, MBA -- and leaders at Tuple Health, published an article in the Journal of American Medical Association (JAMA) Oncology examining the implications of the newly approved standard-of-care immunotherapies within the Centers for Medicare and Medicaid Services' (CMS) value-based payment model, the Oncology Care Model (OCM).
The published work in JAMA Oncology is evidence of OneOncology's commitment to a data-driven understanding of the implications of caring for patients within the OCM and other alternative payment models. OneOncology's physician leadership is actively engaged to help the CMS and commercial payers structure the most appropriate value-based arrangements for patients and practices.
Jeffrey Vacirca, MD, CEO of New York Cancer & Blood Specialists and founding partner of OneOncology, said of the findings: While these findings are informative for the CMS as the agency looks ahead to the next iteration of the OCM, they're also instructive for practices, which should be planning for value-based arrangements now. Alternative payment models are coming fast. For practices to succeed and not get left behind, they'll need to lead through implementation, research and education.
In the JAMA Oncology article, the authors unveil a study conducted at Tennessee Oncology of more than 90 oncologists who treated 2,623 patients in the OCM during the second performance period, which included six-month episodes of care starting between January and June 2017.
The study showed that in over half of the 118 lung cancer episodes with expenditures above the OCM baseline target there were no emergency department visits, hospitalizations, and post-acute care stays. Importantly, in over two-thirds of these cases, expenditures were above target costs solely because of the use of new National Comprehensive Cancer Network (NCCN) recommended immunotherapies, which became the standard of care treatment based on overall survival improvements1,2 after the OCM baseline period.3 The time frame of the OneOncology study occurred after the OCM baseline period determining episode of care costs, which began in 2012 and ended in 2015.
The authors write that these trends suggest, by holding oncologists accountable for the total cost of drugs used during an episode, guideline-concordant use of novel therapies could pose significant challenges to success in the OCM. This is an especially acute concern for practices that could be required to transition to 2-sided risk in January 2020 to remain in the model.
CMMI (Center for Medicare & Medicaid Innovation) has been impressive in building and maintaining a model in a challenging disease for value-based reimbursement models. Their commitment to making methodology transparent allows for clinicians and researchers to continuously analyze and improve the use of the model, the authors said.
The authors recommend that instead of holding oncologists accountable for the total cost of drugs used -- a metric dependent on drug prices beyond an oncologist's control -- a more appropriate lever for CMMI to use to reduce unnecessary drug spending would be to hold oncologists accountable for any inappropriate use of low-value treatment by measuring pathway adherence, which is within an oncologist's control.
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