A survey of oncology practices participating in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) revealed that a “surprising” number of practices are willing to enter into a 2-sided risk arrangement, according to Bo Gamble, Director, Strategic Practice Initiatives, Community Oncology Alliance (COA). Mr Gamble, who discussed these survey results at the virtual 2020 COA Community Oncology Conference, said these results suggest that practices are becoming more comfortable with the OCM, and more confident in their own ability to operate within a value-based care model.
The OCM is a voluntary bundled-payment model with a focus on value-based care; the model was designed to offer incentives to providers to improve care quality and care coordination to lower costs. Last year, CMS began to push practices involved in the model to move from 1-sided to 2-sided risk, after which they would be responsible for paying the difference if they did not meet a target price for services.
Practices participating in the OCM receive regular fee-for-service payments but are also allowed the opportunity to earn more through performance-based payment (PBP) when certain quality and financial measures are met during a 6-month performance period. Mr Gamble explained that last year, if a practice did not receive at least 1 PBP (out of a possible 4 PBPs), they were required to enter the 2-sided risk model to remain an OCM practice.
Between December 4 and December 20, 2019, the COA distributed a 15-question survey to OCM participants. The survey addressed the practice’s previous OCM performance, its decision to continue with or drop out of the program, its decision regarding 2-sided risk going forward, and whether the practice obtained reinsurance.
“We Were Pleasantly Surprised”
When Mr Gamble and members of the COA heard back from 68 of 175 surveyed oncology practices by the Center for Medicare and Medicaid Innovation (CMMI) December 3, 2019, deadline, he said they were pleasantly surprised to see how many practices adopted a 2-sided risk model. At the time, many of these practices had not even received a performance bonus. This willingness to take on 2-sided risk suggests that these oncology practices are confident they can succeed in delivering high-quality and cost-effective cancer care even in the wake of oncology payment reform.
“I was struck by how thoughtful the explanations were [for entering 2-sided risk],” he added. “They had given it much thought, almost as if they were echoing their boardroom decisions. This points to how thorough folks had to be in making these decisions.”
Of the surveyed practices, 47% achieved ≥1 PBPs and decided to stay in the 1-sided risk arrangement. However, what surprised Mr Gamble and his colleagues was the fact that an impressive 32% of practices did not achieve a PBP and decided to enter the 2-sided risk model to remain in the OCM.
“That was really amazing to us, because they had all this time to prepare and try to do well, but they were struggling,” he said. “But granted, it’s a complicated model, and it’s been hard to turn the dials in the past.” According to Mr Gamble, the decisions made by this 32% of practices show that they are confident in the progress they are making in delivering value-based care as part of the OCM.
Another 15% of those practices that did not achieve a PBP decided to drop out of the model altogether, whereas 4% did achieve a PBP, but decided to enter the 2-sided risk arrangement on their own accord.
Further Survey Observations and Next Steps
Other observations gleaned from the survey results included practice size (approximately 680 physicians going forward with 2-sided risk), decisions regarding reinsurance (average physician group size taking reinsurance was 17), and the logic and processes behind each practice’s decision to enter the 2-sided risk model.
The major themes identified in terms of reasons for taking on 2-sided risk included expectations to perform better in the OCM, a 2-sided risk model being seen as “the future,” and the reassurance provided by a change in the model dubbed the “safe zone.”
A practice enters the “safe zone,” when their actual costs fall between the OCM’s targeted and benchmark costs. The practice does not earn a PBP, but also does not owe money to CMS. The results of the COA survey reveal that the opportunity for being in the safe zone has made 2-sided risk a bit more palatable for many OCM practices.
“The biggest theme was that they expected to do better,” said Mr Gamble. “And I think that seems to be the theme in all of community cancer care. We always want to do better, and it was encouraging to see that commitment.”
Considering the current climate, Mr Gamble says they have asked CMMI to delay 2-sided risk for the current performance period, and to extend the OCM. “People are focusing on care, and sometimes the focus on care during this time works contrary to the goals of the OCM,” he said. “So, we’ll continue to watch reports and monitor self-sufficiency.”
He said they also want to continue to improve practices’ understanding of the math involved in 2-sided risk, and to focus on detailed strategies for lowering the total cost of care for all involved partners and stakeholders.