COA Payer Exchange Summit Preview: Payment Reform Goes on Amid the Pandemic

Starting tomorrow, The American Journal of Managed Care® (AJMC®) will present coverage from the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform. This 2-day event of cancer care stakeholders has become known for its candid discussions of where progress is happening—or not happening—in payment reform.

The coronavirus disease 2019 (COVID-19) pandemic is impossible to avoid—starting with a meeting in a virtual format—but a look at the COA agenda shows that payment reform continues despite the new reality. Bo Gamble, director of Strategic Practice Initiatives, will kick off the meeting Tuesday with his talk, “The State of Oncology Payment Reform: Ongoing Models, Pilots, and Projects.”

COA has been active in developing concepts for a successor to the current Oncology Care Model (OCM) which had been scheduled to end this year, but has been extended by the Center for Medicare and Medicaid Innovation due to the pandemic. Sessions will include a discussion on the COA-developed OCM 2.0.

In an interview prior to the meeting, Gamble said COA has strived to help practices that had embraced 2-sided risk under the OCM navigate the unforeseen circumstances of a pandemic—something never envisioned in the model. Community oncology practices have seen a huge drop in referrals as fewer patients sought mammograms or screenings for colorectal or prostate cancer, Gamble said. And that fallout is being felt everywhere, from revenue challenges to patients who are now presenting with more advanced cancers.

Of the COA member practices, Gamble said, “We’re trying to figure out a way what we can do to help them as best we can. Because it's not like you can create business, if you're in cancer care. A lot of it is just trying to get practices to hold on and do what they can and manage your staff accordingly,” he said. Practices must, “get creative and follow up with your patients.”

AJMC® will also cover the panel discussion, “The Impact of the COVID-19 Pandemic on Oncology and Payment Reform,” featuring Glenn Balasky, executive director, Rocky Mountain Cancer Centers; Lucio Gordan, MD, president and managing physician, Florida Cancer Specialists & Research Institute; and Debra Patt, MD, PhD, MBA, vice president, Texas Oncology. Ted Okon, MBA, executive director, Community Oncology Alliance, will serve as moderator.

Gamble will moderate a panel, “Deep Dive: Updates From Three Ongoing Oncology Payment Reform Projects,” that will feature Marc Cohen, manager of Value Partnerships, Blue Cross Blue Shield of Michigan; Bhuvana Sagar, MD, national medical executive for Cigna Health Care; and Kim Woofter, executive vice president, Michiana Hematology-Oncology, P.C.

In recent years, COA’s Payer Exchange Summit has featured sessions on the interests of employers who pay for cancer care, and this year’s meeting will be no exception. Lalan Wilfong, MD, executive vice president, Value Based Care & Quality Programs at Texas Oncology, who serves as COA Payment Reform co-chair, told AJMC® in an interview, that the pandemic has created new concerns for employers.

“The biggest concern that employers should have about this is the delay in diagnoses. We know that screening—mammography screening, colonoscopies, for example, can catch cancers early where they are much more easily treated. And so employees can get treated and get back to work very quickly, versus waiting for that cancer to progress and present at a later stage,” Wilfong said.

This, in turn, “has negative impacts on patient survival, as well as people's productivity because the treatment protocols can be much more onerous on patients as their cancer as their cancer stage is higher.”

Highlights of Wednesday’s session include a panel discussion, “Biosimilar Opportunities, Challenges, and Realities,” featuring Kathy Oubre, MS, Chief Operating Officer, Pontchartrain Cancer Center; Kashyap Patel, MD, chief executive officer of Carolina Blood & Cancer Care Associates and COA Payment Reform co-chair; Lauren Vela, MBA, senior director, Pacific Business Group on Health. Jeffrey Vacirca, MD, FACP, chief executive officer and managing partner, New York Cancer & Blood Specialists, will serve as moderator.

And A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan, will moderate the panel, “Applying Value-Based Insurance Design (VBID) in Oncology.” Panelists include Neil Goldfarb, president and chief executive officer of Greater Philadelphia Business Coalition on Health; Alti Rahman, MHA, MBA, CSSBB, practice administrator, Oncology Consultants; and Barry Russo, MBA, Chief Executive Officer, The Center for Cancer and Blood Disorders.

Several participants are members of the editorial leadership at AJMC® or its publication for cancer care stakeholders, Evidence-Based Oncology™ (EBO). Fendrick is the co-editor in chief of AJMC®, while Patel is the associate editor of EBO. Gamble, Gordan, Oubre, Wilfong, and Patt, along with panelist John Fox, MD, medical director for managed care at OneOncology, are members of the editorial board for EBO.

Rose McNulty contributed to this report.