The demands of value-based care have continued to evolve since oncologists began transitioning from fee-for-service to fee-for-value reimbursement more than five years ago. For community-based oncology practices, more change is coming with the introduction of the Oncology Care First Model, the successor of the current Oncology Care Model (OCM). Following a one-year delay caused by the pandemic, the Centers for Medicare & Medicaid Services is expected to launch the Oncology Care First Model in 2022 and will likely include a larger number of practices than the OCM.
A significant number of oncology practices have struggled to adapt to the new reimbursement models. A recent Oncology Insights survey by Cardinal Health Specialty Solutions found that more than one-third of participating oncologists find meeting the demands of government-sponsored value-based care programs “difficult” (31%) or “very difficult” (6%).1 The views on programs offered by commercial payers are similar. Navigating the payer landscape and reimbursements emerged as the top challenge (27%) followed by identifying cost-reduction opportunities (19%), tracking costs across an episode (18%), and clinical decision support (16%).1
Compounding these challenges, only one in four participating oncologists said they are satisfied with existing technologies to support their success in value-based care models. Survey participants cited a need for technology solutions that provide seamless integration into current workflows (25%), interoperability across platforms (21%), cost information (15%), and an ability to dynamically consume clinical guidelines (13%).1
New solutions to address these unmet needs are emerging in the marketplace. Cardinal Health recently introduced Navista™ TS, a suite of artificial intelligence (AI)-enabled, integrated tech solutions for value-based care. Navista™ TS is the only fully integrated resource that enables oncology practices to balance clinical and financial decision-making with connected tools and data-driven insights.2 Navista™ TS incorporates 4 key solutions, which are available as standalone tools or a fully integrated suite.
In value-based payment models, community oncologists are engaged in one-sided or two-sided risk arrangements in which the target price of an episode is often set based on a number of patient-specific conditions, such as cancer type and comorbidities. Until now, oncologists and administrators have been challenged to find effective ways to track costs of care during the episode of care to inform decisions and predict financial performance in these models.
“We get the massive data dump from [the Centers for Medicare & Medicaid Services] quarterly, but it’s always from one to two years ago,” said a value-based care coordinator speaking about the need for viewing episode costs sooner at the Oncology Group, Austin, TX. “We don’t know if our new programs are affecting any change until one to two years later.”
Episode Analytics tracks costs during an episode of care to inform care decisions and estimate treatment costs in advance. As a result, practices can more accurately predict performance in value-based care models and measure the cost-effectiveness of quality initiatives without delay. That means practices do not need to wait 18 months to see how they fared in a performance period. Visibility into cost data earlier enables practices to make more informed decisions and to make appropriate adjustments midstream.
Value-based care models aim to provide higher quality, highly coordinated oncology care at the same or reduced costs. Navista™ TS includes CORE™, an AI-enabled population health tool by Jvion, which identifies at-risk patients among vast populations as well as those on an accelerated path to becoming high-risk, by mining unique socioeconomic and health data sets.3 CORE enables oncologists to go beyond traditional predictive analytics and intervene impactfully.
The insights gained through CORE provide prioritized clinical recommendations for patients at risk for mortality within 30 days, avoidable inpatient admission, emergency department visits, and more. This intelligence helps oncologists drive meaningful clinical outcomes, prevent adverse events, and deliver the right level of care in each patient’s journey.
Practices using Episode Analytics combined with CORE will be able to gain even greater insights by seeing accurate patient risk profiles for 30-day mortality, six-month deterioration, emergency department admission or readmission, pain, or depression directly in the tool. These two solutions used together will allow practices to effectively manage risk and the additional higher costs associated with the risk for certain adverse events.
“Referring patients for hospice or palliative care is never an easy decision but failing to do so when the patient could benefit ultimately worsens the patient’s end-of-life experience,” said Sibel Blau, MD, Medical Director, Northwest Medical Specialties, Puyallup, WA, and Co-Founder, President, and Chief Executive Officer, Quality Cancer Care Alliance. “AI helps us to make these difficult decisions, saving not only treatment costs but also unnecessary suffering and emotional turmoil for patients with terminal cancer and their caregivers.”
More than 13,000 interventional oncology clinical trials are recruiting patients, yet patient participation is estimated at just 3%.4 To find a solution, Cardinal Health has collaborated with Deep Lens to provide VIPER, its AI-enabled cancer clinical trial matching solution. VIPER matches patients to precision oncology trials in real time to overcome common obstacles such as limited resources, narrow trial eligibility requirements, and operational efficiencies. It also satisfies OCM requirements of offering clinical trials, utilizing evidence-based medicine, and supporting patient navigation and continuous improvements driven by data.
“We prioritize superior patient care and strive to always leverage the most novel technologies, tools, and resources that allow us to meet a variety of unique, diverse, patient needs,” said Chris Barnes, Executive Director, Alabama Oncology, Birmingham. “Part of this includes ensuring that all eligible patients have access to emerging cancer therapies in development through clinical trials. We are delighted to integrate VIPER into our network and are confident that we will be able to offer optimal, timely, and cutting-edge care to the patient communities we serve.”
As mentioned earlier, the Oncology Insights survey found that issues such as seamless integration into current workflows and interoperability across platforms are key concerns for oncologists participating in value-based reimbursement models. To address these issues, Navista™ TS includes the award-winning Oncology Cloud Platform by CureMD that helps oncology practices simplify decision-making, streamline operations, and comply with evidence-based guidelines.
The all-in-one platform enables practices to bypass the stress and cost of integrating fragmented, standalone solutions and supports the seamless exchange of information across multiple platforms, including electronic health records, practice management systems, revenue cycle management services, telehealth, and patient portals.
As the most comprehensive solution for value-based care, Navista™ TS empowers oncology teams to confidently make the best decisions that improve patient care and financial performance. Looking ahead, the demands of value-based care will continue to evolve, but the introduction of Navista™ TS will provide the tools to help oncologists keep pace and thrive.
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