The US Oncology Network boot camp provides expertise, gathers feedback about value-based care

by Marcus Neubauer, MD

The US Oncology Network recently held its second annual boot camp focusing on value-based care.

More than 100 stakeholders and leaders met for the intensive 2-day workshop, a collaborative effort of The US Oncology Network and McKesson Specialty Health.

This type of boot camp is extremely helpful because we are in unknown territory as we transition from volume-based reimbursement models to those focusing on delivering value.

Some of the new models are very complex, especially the Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM). This program has 190 practice participants but, unfortunately, it is hard for them to understand and meet all requirements. The periodic rule changes, frequent updates and complex reporting requirements make it very difficult for practices to implement on their own.

The boot camp was designed to help practices meet the challenges of the OCM and other value-based models by taking advantage of the shared expertise within The US Oncology Network, an organization of like-minded, independent oncology practices — including 14 practices that are participating in the OCM.

The meeting was a two-way exchange. Experts from The Network educated and informed practices. They also gathered feedback from practices that have had early success, particularly those that have developed creative and reproducible ways to meet OCM program requirements.

Event highlights

Much of the workshop emphasized key elements that are critical to success in value-based models.

Discussion focused on topics such as:

• Leading change while managing daily operations.

The OCM drives fundamental change throughout the entire practice by requiring all physicians and ancillary staff to understand and participate in the program. This is challenging to accomplish in addition to an already busy work day. Much of the discussion focused on strategies for practice leaders, quality leads and physician leaders to drive change in their respective areas.

• Using team huddles to raise quality of care and staff engagement.

Many practices have adopted team huddles to improve care and have found them to be useful. Although they do take time, they enable the care team to identify high-risk patients early in their treatment, potentially mitigating expensive, avoidable events, such as hospitalizations and ED visits. We also learned any staff member — such as the receptionist and the social worker — also can play a role in identifying patients who may need extra care.

• Sharing and utilizing data.

The OCM generates a lot of data, so there was much interest in how to interpret and share data so they do not just sit on someone’s desk ignored.

One of the requirements for OCM participation is to use data for continuous learning. We are grateful for the rich data sharing from CMS in the OCM, but it takes time to mold the data into interpretable reports.

In addition to receiving data from CMS, the practice also is required to submit practice-derived data to CMS. The first submission period was graded on the practice’s ability to report. Future periods will include performance benchmarks. Practices need to figure out now how to achieve these performance metrics.

• Identifying patients on oral therapies.

Because patients on oral drugs take them at home rather than in the clinic where they can be tracked, identifying these patients is difficult. Part of the boot camp program focused on a practice that developed a system to use Medicare data to identify patients who get oral drugs, rather than relying on the practice’s own data. Practice representatives who attended the boot camp were impressed with the idea, replicated the algorithm and are having success with it.

• Structuring a practice for 24/7 care.

Organizing practices to accommodate 24/7 care so patients do not end up in the ED unnecessarily is a major challenge. Boot camp participants discussed strategies to redesign work flows and triage phone calls to make the practice more available and provide better management of patients while controlling costs. Studies have shown that longer wait times for appointments lead to higher rates of ED visits.

• Setting goals.

Practices need to know how well they are managing quality and total cost of care, enabling them to set goals for improvement. Goals must be individualized, at least to some degree, and practices must understand what is achievable given their own circumstances.

Key takeaways

It became clear during the boot camp that the OCM is a difficult program for practices to implement and run while continuing with their core mission of providing quality patient care.

Many attendees verbalized how helpful it was to have support from The US Oncology Network when implementing large, complex initiatives like the OCM.

The Network and McKesson Specialty Health have devoted a substantial amount of time, effort and resources to develop expertise and innovative technologies to help practices succeed in the OCM and other alternative payment models. All 14 Network-affiliated practices that are participating in the OCM were represented at the boot camp by a physician-led team, demonstrating these physicians felt the event was important enough to take time away from their busy practices to attend.

It also is clear that practice transformation does not happen quickly. Because the OCM is a 5-year program, there is no need to panic. Transformation is not something that should be done rapidly; however, practices should not procrastinate. They must start moving toward transformation by trying to do things differently, such as changing workflows and hiring new staff to provide enhanced services expected in the OCM.

Practices also must have up-to-date technology to run programs like the OCM. Large practices are enrolling more than 1,000 patients a month, so robust technology is essential to support this high volume.

Lessons learned

The boot camp revealed several similarities in value-based care models, including the OCM.

Providers must demonstrate cost-savings. That does not necessarily mean spending fewer dollars than in the past, because expensive new technologies and cancer drugs make this impossible.

However, they can spend less than predicted, demonstrating they can manage costs better in the program than they would if they did not participate.

Value-based care models also require attestation to quality by reporting on certain metrics. Practices need to be proficient in identifying, documenting and reporting these metrics. Documentation should occur as care is delivered, as it is very difficult to go back and update the electronic health record. Although this requires more work upfront, it is a critical component of practice transformation.

Lastly, value-based care models require a practice-wide effort and commitment. All physicians and staff must attempt to understand the program, accept it and work toward success.

Although many uncertainties surround the transition to value-based care, one thing is clear: There will not be a return to the traditional fee-for-service model of reimbursement.

The new models for cancer care are stepping stones to how cancer treatment will be reimbursed in the future, and the time is now for practices to start adapting.

The government — and private payers — will continue to support value-based care while gradually shifting more risk to practices. Consequently, practices that can manage risk while providing high-quality patient care will be the ones that will thrive in the new value-based landscape.

For more information:

Marcus Neubauer, MD, is vice president and medical director for payer and clinical services at McKesson Specialty Health and The US Oncology Network. He can be reached at marcus.neubauer@mckesson.com.

Disclosure: Neubauer reports no relevant financial disclosures.