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ASCO Updates Its Oncology Medical Home Payment Model, Putting Patient Needs Up Front

April 2020, Vol 11, No 2

In January 2020, the American Society of Clinical Oncology (ASCO) issued a major update to its Patient-Centered Oncology Payment (PCOP) model, an alternative payment model “designed to support transformation in cancer care delivery and reimbursement while ensuring that patients with cancer have access to high-quality, high-value care,” according to a statement from ASCO.

ASCO submitted the updated PCOP model for consideration by the Physician- Focused Payment Model Technical Advisory Committee (PTAC), an advisory group to the Department of Health & Human Services.

PCOP is an oncology-specific physician- focused payment model that aims to offer a solution in the transition from fee-for-service to value-based care delivery. “Specifically, ASCO’s data show significant potential for PCOP to yield cost savings—up to 8% across the healthcare system—while helping to ensure that patients have access to high-quality, high-value care,” ASCO said in a press release.

Enhanced Payment Model

The updated payment model would be community-based, which is intended to be implemented in multidisciplinary networks of oncology providers and practices; federal, state, and private payers; employers; and regional health networks that are aligned to support patient- centered cancer care.

If implemented as a single-payer model, ASCO is encouraging payers to maintain the stakeholder collaboration components of the PCOP model.

The updated model uses 3 major approaches to transform cancer care:

  1. Improved care delivery and coordination through an oncology medical home framework
  2. Performance-based reimbursement model based on patient-centered standards and transitions to bundled payments
  3. High-quality care delivery using clinical pathways.

The support of the committee “and participation by the Medicare and Medicaid programs would advance this model in its intent to establish communities of providers and payers working together to improve cancer care delivery,” said Clifford A. Hudis, MD, ASCO’s Chief Executive Officer, and Stephen S. Grubbs, MD, ASCO’s Vice President, Clinical Affairs, in the submission letter to the PTAC.

The PCOP payment model is designed to evolve as the program progresses, with a focus on:

  • Monthly care management payments to support treatment planning, care management, and active monitoring
  • Performance incentive payments based on quality measurement, cost of care, outcomes, and adherence to evidence-based clinical pathways.

Benefits to Patients, Providers, and Employers

For patients, the establishment of the PCOP would mean improving the patient experience and greater access to state-of-the-art cancer care, according to ASCO, and for providers, the PCOP design would enable a transition to value- based care. For employers and health plans, the new model would help to incentivize quality care and control costs.

Under the proposal, providers could enter 1 of 2 tracks. Practices that opt for track 1 continue to receive fee-for-service reimbursement in addition to the care management amounts. Practices that choose to disrupt the fee-for-service model (track 2) will participate in consolidated payments for oncology care.

Under this option, practices may elect to bundle 50% or 100% of the value of specified services, and 90% of bundled amounts will be guaranteed under this payment model, whereas 10% of bundled amounts will be subject to the same performance adjustment as monthly performance incentive payments, times a 1.4 multiplier.

Performance transparency is a key goal of the model, with open sharing of costof- care data, including provider access to detailed claims data and utilization figures. These cost-of-care data are meant to identify opportunities for high-value care delivery, and invest in a more efficient care delivery, according to ASCO.

The full oncology medical home model report can be found at https://practice.asco.org.

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