FCS’ Walcker Outlines His Hopes for Successor Model to OCM

In the second of 2 parts, Nathan H. Walcker, MBA, CEO of Florida Cancer Specialists & Research Institute (FCS), discusses what he’d like value-based care to look like going forward. CMS ended the Oncology Care Model (OCM) yesterday after 6 years and has invited practices to apply for a successor model, the Enhancing Oncology Model.

This transcript has been edited for clarity.

Transcript

What has been your experience regarding the notion that value-based care requires buy-in from top-level executives?

At FCS, we’ve been very proud of the model that we’ve adopted and scaled across our 100 clinical sites across Florida. We haven’t trademarked it, but we’ve coined the term “regional accountability.” What that means is recognizing and appreciating that there’s both a global approach and a local approach, and it asks, “What is the change management that we will need to do from a macro perspective across FCS, but at the same time, give due credit to the fact that health care is local?”

It recognizes that treating your patient in Tallahassee may be different than treating your patient in Naples, which could be a byproduct of different demographics in these markets, or different physicians, or other factors. We’ve adopted this regional accountability model, and we’re pinpointing champions in each specific market. Then, we’re aligning that to the broader company, by making sure that if we’re looking at something like the adoption of biosimilar [agents], we are asking, “How do we best effectuate and communicate the opportunity, but also still give credence and autonomy to the local position in that market, with respect to the disease mix, etc, that the physicians may be treating on a day-to-day basis?”

At the end of the day, physicians are competitive beings by nature. So, we have found that recognizing that regional accountability, being intentional, and coupling that with benchmarking and reporting has been very successful throughout our time in the OCM.

It’s an approach—the physician scorecard—that we’ve adopted in many of our other alternate payment models with commercial partners as well. We are removing the ambiguity around someone’s performance and then showing them, based on a benchmark, how they are doing vs their peers. How are they doing vs the broader OCM program?

And importantly, where are their opportunities to improve? The issue could be communicating [information about] biosimilar adoption where clinically appropriate, taking opportunities to best stratify your risk with [Hierarchical Condition Categories] score capture, or even doing something as simple as engaging with our care management professionals in a different way, to make sure that our patients appreciate that they have the opportunity to pick up the phone and talk to an oncology-certified nurse 24/7/365.

That’s really been among the silver linings with OCM—that we’ve taken the opportunity to be really intentional with investing in that regional accountability model. It has paid off for patients and for our physicians as well.

What would you like to see in a future iteration of the OCM, and what role should community oncology have?

The best model starts with recognizing that no 2 practices are alike, just like no 2 people are alike. No 2 patients are alike—certainly not in oncology. So, I’d like to see a model that is flexible, one that allows practices to opt in and opt out of risk where they deem appropriate. Given the onslaught of risks and threats, candidly, that community oncology faces—whether from pharmacy benefit managers, drug pricing reform, or challenges to the traditional buy-and-bill model—many variables are at play that certainly call into question the ability for community oncology practices across the country to survive.

Whatever model comes to fruition, the next evolution really needs to be meeting practices where they are and make sure that folks feel comfortable as they walk toward risk. If they’ll be moving to a model where they are not only providing opportunities for upside savings but electing to take downside risk, [they have to know that] they’re able to do so without finding themselves in a very precarious position.

At the end of the day, given the sticker prices and the inflation we’ve seen in drug prices [of late, we know] it can take only 1 or 2 bad events to potentially bankrupt the practice. Cancer care is too important for that to be a risk factor. The next evolution of the model needs to provide, again, the visibility and transparency for somebody to perform in an alternative payment model and know what the metrics are. How are they being reported? Are we making sure that whatever benchmark somebody is being managed to, or being asked to manage to, has been done in a transparent, fair way? An interesting thing we’ve seen at FCS—not only with OCM, but with other alternative payment models that have been incubated with commercial payers—is that everyone has a different rubric or a different scorecard or quality metric.

This makes it challenging for a community of like-minded stakeholders—payers, providers, and patients—aligned around the notion that we want to be delivering the care and the experience and outcomes that you or someone you love would want. That model needs to recognize that and to make sure that we’re balancing the financial incentives with the right clinical protocols and doing so in a fair and transparent manner.