Dr Lalan Wilfong on Learnings From the OCM and Challenges Ahead of the EOM

Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network, shared insight into lessons learned from the Oncology Care Model (OCM) and looked ahead to the Enhancing Oncology Model (EOM) ahead of a panel discussion at the 2023 ASCO Annual Meeting.

Transcript

Your panel will cover what practices learned from the Oncology Care Model. Asked another way, what are the elements that commercial plans have been most likely to replicate?

The Oncology Care Model provided a lot of learnings for value-based care and alternative payment models. Commercial plans have utilizes some of that in their own designs. Specifically for commercial plans, reductions in hospitalizations and emergency department visits are important to them as a cost-saving measure. Navigation is also something that many commercial plans want to see more of, and our ability to provide that whole-person care to the members of a commercial plan. Shared savings has been more complicated for commercial plans to to embrace because it gets very complicated to do shared savings in a commercial plan versus a large model like the Oncology Care Model with Medicare. So that's been a little bit more challenging for them, but the care navigation, reduction hospitalizations [and] emergency department visits have been something that commercial plans have adopted.

Some practice leaders have told us that although they did not join the OCM, they have deployed some elements to improve care. Do you hear this as you speak with oncologists and administrators?

I've definitely seen adoption of many of the components of the Oncology Care Model for practices that weren't participating. For example, shared decision-making and creating a care plan is something that patients really want. And so just to maintain competitiveness in your markets, where patients want to come visit and see you in your clinics, many patients now are asking for these care plans, wanting to know what chemotherapy [they're] getting and the side effects and what type of cancer they have, and things like that.

Many patients are also expecting navigation services and help [preventing] them from going to the hospital in the emergency department. You have to adopt some of these features just to make sure you're you're providing good care for your patients and so they want to keep coming back to you and your clinic. I think gone are the days where patients will just blindly go to their oncologist without having that additional support, because they'll find somebody else. And so just to improve the care that you provide is important for your patients and wanting them to keep coming back to your clinic.

Your panel will take place as practices are deciding whether to take part in the Enhancing Oncology Model. What areas of concern about the EOM has the Center for Medicare & Medicaid Innovation (CMMI) addressed? What areas remain unresolved?

CMMI has been responsive to some of the questions that we've asked, delaying some things like a health equity plan, which they've said now is not required at the very beginning of the model but will be required it within 90 days. Some things like that they've tweaked for us. Challenges that practices have seen are the delay in the data—we just got our data from CMMI a little more than a week ago. It's led to some angst amongst the practices about being able to really look at that and see and prepare themselves for the model and ensuring that they will be successful going into a two-sided risk model. So that's been one of the biggest challenges that we've seen.