The Oncology Care Model
The Cancer Care Burden
The estimated expenditure for cancer care in the United States was $147.3 billion in 2017. In 2016 alone, the estimated number of cancer survivors was 15.5 million and it is set to increase to 20.3 million by 2026. These statistics point to the effectiveness of cancer research and care in the current US healthcare industry climate.
But there is a flip side. Cancer care costs continue to increase as care providers adopt more effective but expensive procedures as the standard of treatment. This has led to Oncology becoming the most expensive medical specialty which is also highly fragmented and inefficient.
The Influence of Financial Incentives on Care Delivery
The fee for service system conjoins care reimbursements and the quantity of the services performed. This only motivates physicians to include more services in the care process, upping the financial burden on patients who are already enduring the physiological effects of cancer.
The current cancer care methodology requires a revamped model that is driven by improved care coordination, accountability of performance from providers, and precise, quality measurement systems.
The Oncology Care Model
The Oncology Care Model (OCM) is among the newest payment models to come from the Center for Medicare and Medicaid Innovation. It constitutes episode-based structures where each episode spans six months of care, following the first instance of chemotherapy. OCM currently combines the Fee-For-Service (FFS) payments model with performance-based payments, taking into account the quality of care delivered by cancer care specialists and comparing them against treatment benchmarks.
The primary goal of the innovation center, with the OCM, is to incorporate the benefits of value-based care and slowly move away from the prolific FFS model which is the current industry standard for specialty care. By incentivizing high-quality, coordinated care, the CMS may have just set off a trend that will slowly persuade more and more cancer care specialists to transform into participating entities.
Monthly Enhanced Oncology Services (MEOS)
Specialty care instances require enhanced services such as care management. These services also generate sustainable cost savings in the form of well-coordinated care processes. Providers that participate in the OCM receive a monthly fee once their patient begins chemotherapy. This sets the precedent for care providers to unlock opportunities for shared savings when they meet the quality targets established by the OCM payment system.
Oncology practices across the US are now set to receive $160 per month per beneficiary for every six-month chemotherapy period. This quota is further augmented with the opportunity to earn shared savings in the event of providers exceeding the target price.
All the participating entities were initially evaluated on a series of 12 quality measures across four domains which are:-
- Communication and Care Coordination
- Clinical Quality of Care
- Patient Safety
- Experiences and Outcomes Centered around Care-Givers
These measures have been phased gradually into 6 quality measures which are now used to evaluate practice performance.
The value of care is determined by the efficiency of the effort that goes with it. With high specialty care domains such as cancer care, the delivery of high-value care is possible only with care coordination and better patient engagement.
To amplify the effects of OCM on the value of care, technology is a key enabler in the continuum of care. Here are the primary opportunities that cancer care providers can leverage to consistently deliver high performance that will translate to better incentivization of treatment.
Care Planning and Management: The efficient allocation of resources to perform common medical procedures for cancer diagnosis such as endoscopy, spirometry, cystoscopy is a crucial first step of the cancer care planning process.
Population health analytics services and care management tools such as patient stratification applications, care team coordination software suites, patient intake management tools, and care companion mobile apps are some mainstream technologies that care providers need to look at. These tools will enable providers to stratify treatment risks, schedule patient monitoring, address eligibility screening, and identify high-risk patients.
Care Coordination: Core patient navigation functions to acclimatize patients with medication management, palliative services, and changes in care settings have shown better coordination between patients and caregivers.
Referral management software suites and customized CRM solutions are the ideal solutions that caregivers can use to improve completion rates of referrals and resource utilization. These systems also effectively use data from EHR systems to help care providers monitor historical patient referrals and treatment details.
Patient and Caregiver Engagement: One of the simplest and cost-effective ways for cancer care specialists to enhance patient and provider engagement is through the use of mobile applications. Mobile apps can be designed for a wide variety of tasks ranging from providing access to patient portals to the secure mailing of medical information such as medication details and treatment schedules.
mHealth is on the rise and the versatility of mobile apps for the cost involved in their development is one of the reasons behind it. Both doctors and patients can closely coordinate with each other to strengthen engagement between them which will lead to better care coordination.
The Oncology Care Model was conceptualized to promote the delivery of high value, coordinated cancer care at a much lower cost to Medicaid. While the model itself has immense potential to introduce vital changes in cancer care, it requires the golden touch of technology to help cancer care specialists reduce the overall cost of treatment.
Nalashaa’s product engineering, interoperability and data services assist providers and ISVs to implement the key services that will augment the efficiency of the Oncology Care Model.
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A writer in Healthcare domain, who is also a science and technology enthusiast. Enjoys creating interesting pieces that elucidate the latest Healthcare IT trends and advancements.All stories by: Puneeth Salian