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A year into OCM: Five key challenges

By: Alyssa Dahl

DataGen’s article was recently featured on

The first 12 months of the Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM)  has been a significant learning experience for participants.

Practices have had to come to grips with how different OCM is from other bundled payment models like the Comprehensive Care for Joint Replacement (CJR) or Bundled Payments for Care Improvement (BPCI) programs, which have clear-cut provider attribution and target prices at the time of episode initiation. OCM is a unique animal, demanding a sharp understanding of the program―however, many of its quirks have only fully emerged over the course of the past year. Here are the top five lessons learned for participants:

1. It’s critical to grasp OCM’s nontraditional bundle framework: Oncology patients are likely to receive several opinions upon diagnosis or advancement of disease and thus receive care at multiple practices throughout an episode of care, so it can be unclear how to identify which practice was ultimately most responsible for the patient’s care and should “own” the episode. CMS’ solution to this challenge is an attribution method based on visit frequency, but this can raise some major challenges. Many practices find that they are unsure of which patients’ episodes they will ultimately own. In a performance period, a practice may see 600 Medicare beneficiaries for oncology services, but only a fraction of those will actually be attributed to them at the end of the episode—a consequence of the retrospective practice assignment that’s emerging as analysts review the claims data covering the first performance period.

2. Strategies are needed that are different from those in other bundled payment programs:Participants in programs like CJR know there are a few things to target to ensure effective treatment across an episode: readmissions, post-acute care and preferring home health instead of nursing homes for low-acuity patients. Those methodologies do not necessarily work when it comes to OCM. Nearly half the cost for the ten cancer types with the largest episode volume is for the chemotherapy drug alone—a cost that a practice is not likely to be able to change. There are several alternative cost drivers OCM practices should consider, including:

  • inpatient admissions, such as those that may be unplanned or unrelated to cancer care;
  • emergency department utilization;
  • ancillary services, such as lab and imaging costs;
  • supportive cancer therapy drugs, such as bone density supports, antiemetics, and others that can contribute to the cost of care; and
  • the cost of utilization of services at the end of life.

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