Dr Basit Chaudhry on Challenges With Improving Performance Under OCM

Part of the challenge has been the distribution of cost structure under the Oncology Care Model (OCM), particularly with respect to pharmaceuticals, explained Basit Chaudhry, MD, PhD, founder of Tuple Health.

Transcript

For practices participating in the OCM that have not improved in performance period 3, what are their biggest challenges in trying to do so?

It’s a complicated subject, and there’s different kind of buckets of where is performance lacking. I’d say that overall, there’s been really good progress it seems, in aggregate, around preventing hospitalizations and doing things like that—skilled nursing facility utilization, diminishing that. I think part of the challenge has been the distribution of the cost structure, particularly with respect to pharmaceuticals. I think for many participants, they feel like that’s largely out of their control. They feel that their care is roughly in line with the evidence-based guidelines, particularly NCCN [National Comprehensive Cancer Network] guidelines. So, the price of pharmaceuticals is difficult for them to manage, and they feel like it’s outside the span of their control. So, I think this has been one of the occurring issues.

I think other issues in terms of performance, I think one thing we see is for many practices, it’s been hard for them to actually interpret what’s driving their performance, particularly what cancers are problematic with respect to methodology or where are they going over, understanding what’s driving that, how effective are different interventions they have going on. There’s a constellation of different issues. I think parallel to that, there are different issues related to the model’s methodology itself. Are prices being projected accurately or in line with what’s actually happening? Things like that. There’s a lot of complex financial modeling that’s involved in OCM, and a lot of what’s being done is predicting prices, and that’s a complicated thing to do in a domain such as oncology.