In June 2019, the Community Oncology Alliance (COA) announced a detailed alternative payment model (APM) that includes proposals for value-based contracts that would provide high-quality oncology care at a low cost. Oncology Care Model (OCM) 2.0 was a highly anticipated response on COA’s part to the Center for Medicare & Medicaid Innovation’s (CMMI) OCM.
Launched in 2016, CMMI’s OCM has been credited by participating oncology practices as helping them improve the way they deliver cancer care, but the same practices have criticized some of the program’s shortcomings.
As host to a peer-to-peer network of participating OCM practices and a strong voice representing independent, community-based cancer care, COA began formulating a patient-focused payment model that would improve on the OCM. In developing the OCM 2.0 model, COA applied the lessons learned and used the feedback of participants in the OCM, as well as other APMs that have followed CMMI’s lead.
OCM 2.0 builds upon the ongoing OCM, including a proposal for value-based cancer drug selection and pricing. If implemented, the OCM 2.0 model aims to streamline implementation and operations for oncology practices participating in the program, as well as address the issue of increasing costs of cancer drugs.
Frederick M Schnell, MD, FACP, medical director of COA and editorial advisory board member of Journal of Clinical Pathways, provided further detail on OCM 2.0 and COA’s hopes for its reception by the Physician-Focused Payment Model Technical Advisory
Committee (PTAC). Dr Schnell was one of the COA members most involved in the design and granular details of OCM 2.0.
Now that OCM 2.0 has been officially launched, do you want to briefly describe COA’s strategic vision for 2.0 from the beginning stages?
Dr Schnell: We wanted to make a program that was adaptable and flexible. OCM 2.0 was designed to be applicable to commercial, federal, or other programs in the oncology space. That was the first priority. Second, we were highly sensitive to what the OCM program has and has not done well.
Our hope at COA is that OCM 2.0 builds upon and improves the OCM program. Provider and plan participants would benefit from quicker sharing of data and an improved alternative payment model.
We were committed from the beginning to try to address the impact of pharmaceutical costs. I do not think any care model that does not bend the current curve is going to have any true applicability or success in the current market. I will admit, it is a huge challenge; you would be hard pressed to find a proposal to control pharmaceutical costs in a way that has worked to date. All along, we prioritized thinking outside the box about issues with federal regulations and how we might be able to allow a program to address those in the quest to control the costs of therapeutics.
Our final goal was to create something that could be implemented without massive investments from practices or abandoning the structural changes to oncology reform models that are already in the marketplace.
One of the featured points of OCM 2.0 is that it “recognizes and rewards high quality and value.” How exactly is this recognition to be manifested?
Dr Schnell: Any practice that chooses to implement OCM 2.0 would be able to see rewards for providing high-quality and high-value care. An important part of demonstrating this is through the Oncology Medical Home (OMH) program and standards that COA established some years ago. We think the OMH would be the anchor to quality from the provider side.
Additionally, OCM 2.0 supports the idea that pharmaceutical manufacturers would be held to a similar standard. In other words, the school of thought is that drugs and therapies should be used because they are effective and because they provide true value. COA has participated in multiple stakeholder discussions on this very topic in the last year or so.
What has been some of the feedback in the comments period? Are you optimistic about PTAC’s response to the proposal and the
comments?
Dr Schnell: It would be a huge step forward for the space if PTAC accepted OCM 2.0 in the spirit intended and focused on the positive changes included in it. At the very least, COA would be honored if PTAC approved it as an acceptable alternative payment model with a much different look than the OMH.
Our hope is PTAC will see the good in OCM 2.0, provide constructive criticism, and accept that the platform is a foundation to adding substance and value in this space.
We have also had great interest and feedback on OCM 2.0 from stakeholders across the oncology world. Since announcing the model, we have received nonstop calls and emails. Many are encouraged that COA is leading the charge with some bold ideas.
