Dr Basit Chaudhry Discusses the Impact of Delayed Care on APMs Like OCM

Delayed care due to the coronavirus disease 2019 pandemic has created a lot of uncertainty around alternative payment models (APMs) like the Oncology Care Model (OCM), said Basit Chaudhry, MD, PhD, founder of Tuple Health.

Transcript

There has been a lot of delayed care and cancer diagnoses because of the pandemic. How do you expect this will impact practices participating in the Oncology Care Model and planning to transition to Oncology Care First?

That's a great question. I think it creates quite a bit of uncertainty in the field. I think Medicare has done a really nice job in terms of creating flexibility, particularly on the downside risk components of advance alternative payment models, including OCM. So, it was a very welcome kind of flexibility and relief there, and I think that's given practices space to think about how do they want to transition to the future?

I do think just because of the pandemic, and unfortunately, the current rise in cases, I think it's unclear on what's going to happen with the public health emergency. And in turn, I think that just creates uncertainty, broadly speaking with respect to advanced alternative payment models, in general. So, I think it's a little bit unclear right now, how long this interim period will last. And I think, in turn, it makes evaluation of the models really difficult because, well, having a downside risk component to them, it makes it very difficult for Medicare to figure out what's working what's not.

So, all of this, there's a ton of some pieces. Unfortunately, I think this makes it quite difficult for Medicare to kind of locate and situate what they want to do. But I do think there's potential that we could see an extension of OCM for an additional period of time whether that’s that 6 months, a year—I think it really is going to depend on what the public health emergency looks like. And then that, in turn, obviously will roll into what the next Medicare model in cancer care looks like.

The big change from OCM to OCF is the movement to a bundled payment framework in oncology. Is it possible to even move to that kind of framework if we are still in a pandemic?

So, if we still are in a pandemic, I think it's very difficult to ascertain what's going to happen with respect to risk. So, I think, as long as we have rising cases, as long as there's a public health emergency, I think it's very difficult to ask people in the provider system to absorb risk, because simply the variance is enormously high. Right? We don't really know what's going to happen, I think, when variance is high in any field. Really, what you need is a very large sample size.

And one of the trade-offs you're making in moving to value-based payments or risk-based arrangements, you're moving from payers covering large bodies of patients with large samples to practices that will have much smaller samples. So, they're much more prone to variance, and outlier effects. So, I think it's very difficult for providers to absorb risk outright, during the pandemic.