Dr Roger Brito Discusses Implementing Alternative Payment Models and Its Challenges

Transcript (slightly modified)

How can payers and practices work together to implement OCM or other alternative payment models?

Our oncology medical home model at Aetna was established in 2014, the third quarter of 2014, and I like to tell our providers that we’re 2 years ahead of the OCM model as far as data and collaborating with our providers. At that point in time is when we enrolled our first OMH practices; we now have 21 practices throughout the United States. They parallel greatly, the oncology care model. We measure quality metrics, we participate in collaboration and communication, sometimes on a daily basis. There’s transparency and data sharing. It’s really an exciting time to be in the payer/provider mix. What we’re focusing on is what I call the healthcare triangle (patients, providers, and payers) and connecting those lines, because we’re both working for the same type of outcome, which is better health, delivery and care of our patients.

What are some challenges with implementing alternative payment models?

The challenges are that there are so many variables. So, do we look at pharmaceutical costs? Do we look at the total cost of the patient from their journey of diagnosing, pre-diagnosing, all the way through their journey, which takes them either to survivorship or end-of-life care? I think that’s where the difficulty lies. How do we assess, or put value on a member or patient’s journey and always keeping quality on the forefront? But, obviously if we can improve quality and maintain costs, or save costs without decreasing quality, that’s the goal, and that’s what we would like. I think the difficulty and the challenges, which segments do we take? Personally, I would love a global total cost care analysis that we could look at, and that would incorporate staging, survivorship, oncology care management, nurse navigator engagement, continuing on the relationship with the cancer survivor, and we know that cancer survivors can sometimes develop different diseases. So, if we’re engaged with our members up-front, we can then provide care for those special conditions they may have developed from having had cancer treatment as we move forward. I think the global model would be ideal; it might be the most difficult, but that would be my preference