PCN221 OCM TO OCF: IMPLICATIONS FOR TOTAL COST OF CARE

Abstract

To map the limitations of the Oncology Care Model (OCM) to the proposed features of the 2021 Oncology Care First (OCF) model in order to evaluate whether the OCF is more likely to successfully reduce total cost of care. The study employed a pragmatic literature review to identify key shortcomings of the current OCM model with respect to lowering total cost of care. Interviews with thought leaders in the field of value-based payment models helped to then shed light on whether the OCF would address these gaps. These findings were mapped to specific features (e.g., two-sided risk, tumor-specific adjustments) proposed for the OCF. Several elements within the OCM have led to participants achieving subpar improvements on total cost and quality of care. These include insufficient consideration of tumor-specific care differences, challenges with accurate patient attribution, diminishing returns from self-benchmarked price targets, and insufficient timely feedback on performance metrics. The OCF attempts to address the first two issues by including new tumor-specific calculation methods and providing prospective payments to any oncology patient managed by a participating practice. However, the partially capitated prospective payment, the requirement for electronic Patient Reported Outcomes (ePRO), and the faster trajectory towards two-sided risk will likely drive a bias in OCF participation towards innovative practices. These practices will continue to suffer from diminishing benefits of further improvement, and with an updated novel therapies adjustment, they may experience an increase in drug-related total cost of care. While the OCF model builds upon the OCM, there are still several components that have been critiqued under OCM and remain unaddressed. Given past OCM experiences, the OCF may ultimately follow a similar trajectory and have limited impact on the total cost of care unless solutions to these issues are included in the final program design.