By Gena Cook, CEO, Navigating Cancer
Consider this sobering statistic: In 2015, only 27% of Medicare ACOs were able to generate enough savings below the benchmark to qualify for a performance-based payment.1 In the coming year, it is conceivable that two-thirds or more of Oncology Care Model (OCM) participants also may not qualify for a year-end, performance-based payment.
Starting January 1, 2017, OCM participants that have been meeting the practice redesign requirements for Monthly Enhanced Oncology Services (MEOS) payments will start being evaluated via a combination of self-reporting, national claims data, and data collected by CMS directly.
How will your practice fare?
The Reality of Qualifying for OCM Performance Payment
The purpose of the OCM is clear: to provide higher quality, more highly coordinated oncology care at a lower cost to Medicare. Less clear is how cancer programs will achieve that objective.
Business as usual isn’t an option. Simply reporting that you’re meeting practice requirements for quality cancer care won’t suffice. If national claims data and CMS’s own data don’t show you’ve lowered costs and achieved a high patient satisfaction score, your practice will be deemed ineligible for the performance payment. You may be disqualified from the pilot entirely.2
All OCM participants want to improve cancer care quality and reduce costs — that’s a given. But it is no small feat to improve the quality of care while lowering costs. How can you reduce avoidable ER visits and hospitalizations without hiring more staff? The reality is, you can’t — at least not with the existing technology and operational infrastructure of most practices.
A new approach to patient care is necessary, and it must involve advanced technology.
Will your practice be able to improve the patient experience?
The launch of OCM marks an exciting chapter for oncology, with providers and payers working together to ensure cancer patients receive the care they deserve. But there’s an unfortunate downside to the model: the very requirements intended to spur better patient care often result in a disjointed patient experience.
As OCM participants scramble to meet a long list of requirements including pain assessments, depression screening, preparation of care plans, providing navigation services and many others, the coordination of these activities is often neglected.
Over the course of care, people in different departments collect the required information bit by bit. Without a way to tie together the information collected in a single patient view, important patient details are never surfaced to the appropriate care team member for action.
The next person to contact the patient won’t have a comprehensive view of what’s been happening or be in a position to provide coordinated, proactive care. The result? The patient feels forgotten and care delivery falls short.
The patient deserves better. Some participants, fearful of failing to meet OCM’s numerous reporting requirements, have adopted a checklist mentality to care delivery. They perform a task, like pain screening, add it to the EMR and move on to the next thing on the list instead of assessing what the patient actually needs. This approach doesn’t lower the cost of care enough for providers to qualify for performance-based payments.
What does lower costs is more proactive patient care. Past payer pilots3 and our own clinic partners4 have proven that facilitating ongoing, open communication between the patient and their care team results in real cost savings and better patient outcomes.
But the pilots were completed with narrow patient cohorts. In order to duplicate their results across broad patient populations, such as Medicare beneficiaries, providers will need to harness the power of new technology.
Taking advantage of innovative technology, clinics can deliver patient-centered care at scale, and improve care coordination, manage populations more effectively, and allow patients more involvement in their own care. For example, instead of being handed a pile of educational material at the clinic when they are likely overwhelmed with the complexity of their diagnosis, treatment options and new terminology, that information can be delivered to the patient electronically.
Automating patient education and self-care instructions across populations will enable providers to provide information to patients in a timely way and provide only information that is directly relevant to them. Remote monitoring of patients — asking them to assess pain or report side effects on a regular basis — enables providers to proactively reach out to patients who need them the most for critical interventions. These are the interventions that will head off unnecessary and costly hospitalizations.
The technology a practice chooses and how it implements the MEOS requirements will determine whether it is able to offer better quality care at lower costs. For example, hiring navigators to help patients reduce the barriers of care, like understanding insurance, selecting a care option or assisting caregivers, will no doubt improve the patient experience. But if the navigator only records their activities in the EMR note section, will care coordination improve?
A care coordination hub puts all care providers — including navigators, care coordinators, social workers, and triage nurses — on the same page. The whole team can easily see what patient activities have been completed, what’s scheduled to happen next, and how the patient is feeling between clinic visits. That’s meaningful patient-centered care.
The Fundamental Role of Patient Relationship Management
For cancer programs serious about the performance payment, now is the time to evaluate new technology solutions to improve patient-centered care and care coordination. The EMR alone simply cannot provide care teams with a 360-degree view of patient care. Hiring additional staff is costly and may be inefficient.
One solution is Patient Relationship Management (PRM) software, a patient-centered operating system that layers over the EMR, providing an interface for patients and their care teams.
The primary purpose of PRM is to stimulate information flow between patients and their care team. With everyone on the same page, patients can get the care they need when they need it — rather than end up in the ER, for example, or make uninformed and potentially adverse decisions about medication side-effects.
When evaluating technology solutions, look for a PRM platform that will enable your practice to:
- Engage and educate patients through targeted self-care instructions and comprehensive care plans containing the 13 IOM requirements
- Proactively collect patient-reported outcomes (PROs) on symptoms, side effects, and psycho-emotional distress and link this data to real-time alerts
- Combine patient-reported outcomes and clinical data within a robust population health analytics and reporting framework
- Create risk-stratified strategies, and corresponding customized programs, to deliver personalized care within and across unique patient populations
- Collect and surface patient-reported outcomes and facilitate proactive triage
- Follow standardized, evidence-based symptom pathways to accelerate symptom management
- Get follow-up reminders to manage your highest need patient populations
- Track patient navigation activities so all care-team members are informed about the last patient interaction
If you are a practice participating in OCM or want to prepare your practice for the inevitable industry-wide shift to value-based reimbursement, it’s time to re-evaluate your technology infrastructure. Your EMR may be enough to get you into the race, but only PRM can get you across the finish line.
- Medicare ACOs Provide Improved Care While Slowing Cost Growth in 2014, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-08-25.html
- Oncology Care Model (OCM) Request for Applications (RFA) February 2015, page 11, https://innovation.cms.gov/files/x/ocmrfa.pdf
- Hoverman JR, Klein I, Harrison D, et al. Impact of a cancer management program. J Clin Oncol. 2012;30(suppl 34; abstr 227).
Newcomer LN, Gould B, Page RD, et al. Changing physician incentives for affordable, quality cancer care: results of an episode payment model. J Oncol Pract. 2014;10:322-326.
- The COME HOME model. http://www.comehomeprogram.com/index.php/come-home-practices/. Accessed September 21, 2016.
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