How US Oncology Network Practices Find Success in the OCM

The US Oncology Network (The Network) recently announced a huge milestone: 100,000 patients enrolled in the Centers for Medicare & Medicaid Innovation’s (CMMI) Oncology Care Model (OCM), which is part of ongoing efforts to shift toward value-based care over volume-based models. Over the course of 6 performance periods in the OCM, which started in 2016, participating network practices have surpassed $122 million in savings for Medicare.

While many community oncology practices have found success in the OCM, it does not come without its difficulties, and results have been mixed. But data reported to CMS show practices in the US Oncology Network have largely been successful in the model, likely due to both to their commitment to practice transformation and resources from the network, which is supported by McKesson.

The American Journal of Managed Care® (AJMC®) spoke with Marcus Neubauer, MD, chief medical officer at US Oncology Network; and Stuart Staggs, senior director of Strategic Programs at McKesson, to discuss the steps that successful oncology practices have taken to improve patient outcomes and system cost savings in the OCM.

Because the model is designed for practice transformation and is so large and complex, it can present challenges for those physicians who take part, Neubauer explained. He cited nurse navigation as one example of a change that required adaptation from practices. Identifying people who could coordinate care throughout a patient’s journey—including setting up technology like electronic medical records and documenting the quality metrics required in the program—is important, he said.

But if a practice is to be successful in the model, the responsibilities cannot all fall on a single member of the practice, or even on just a few.

“Getting your practice to understand the model and participate in it is absolutely a practice-wide undertaking. This is not something that an administrator can do, or 1 or 2 physicians can do on their own, it has to be a practice-wide effort,” Neubauer said. “So there were major challenges with this, but also a lot of opportunity and a lot of excitement in our practices even way back in 2016, to be a part of what they sought to be this transition to value-based care.”

Practices faring well in the model are also keeping closer eyes on their patients, making sure they know to call their regular oncologist before going to the hospital and discussing expectations with each patient in regard to their specific cancer journey, for instance. Staggs also noted that fully embracing the model from a holistic standpoint is one key to finding success in it.

“One of the big things that we're seeing is with practices that have really bought in, they've not only done these activities and enhanced services for Medicare patients; they've expanded those same good habits and broader services to even non-Medicare patients,” Staggs said. “So just having a broader view and really applying all these new learnings to all patients allows for more consistency and better value for every patient, not just Medicare patients.”

Implementing or bolstering electronic means of checking in on patients, like electronic patient reported outcomes (ePROs), is one way that many physicians are working to get feedback from patients and maintain care, even when patients are outside of the clinic’s walls. Given the emphasis on improving care quality while saving on costs and improving patient outcomes, checking in on patients is key.

In any discussion surrounding value in oncology care, drugs are bound to be a topic of interest. In reducing overall costs, steps like using drugs judiciously and focusing on drug initiatives can also help practices succeed in the OCM, Neubauer and Staggs said.

With increased focus on outcomes that save on costs, like minimizing hospitalizations and keeping patients healthier throughout the course of treatment, it’s no surprise that patients also seem to fare well in the OCM.

“Although I only know the experience in our network practices, patients really like it. And the reason they like it is this model is very patient-centric,” Neubauer said. “It drives more touchpoints and more coordination of care. The expectation of this model is to try to close any gaps [in care] and keep things from falling through the cracks, and patient sense this.”

He added that while there is always room for improvement, the fact that patients tend to get more pre-emptive care rather than receiving reactive care once they already feel sicker may be a driver behind largely positive patient reviews of the model.

For practices that haven’t found as much success in the model, it can be complicated to figure out why. For US Oncology Network practices, having the analytics and data that McKesson provides can make a world of difference. But even for those practices that are going it alone, data can help them identify weak spots.

“Prior to the to the OCM, we didn't get Medicare data, so it was sort of a blind area for us. But we are getting data on individual patients that are not only things that have happened to the patient in our clinic, but also the things that happen to them that generate the claims throughout the six month period,” Neubauer explained. “[We see] hospital claims, imaging claims, lab claims, etc.—things that are even out of our control. So we do have a lot of data. And if you can take that data, you can look for patterns, and areas of opportunity.”

Neubauer also counts physician leadership in a practice as an important step to success. Physicians set the tone at a practice and have to be able to get everyone at the clinic—from their own physician partners to nurses, medical assistants, and administrators—working toward the goals of the model, he said.

And while it can be easy to set lofty goals when so much data is available, Staggs advises against it. Like any goal, being realistic is half the battle when it comes to achieving it.

“If you look at practices that try to tackle 8 to 10 things based on what they're seeing in their performance, it's a lot tougher than practices that target the top 2 to 3 things to really improve on. So if you can really prioritize, of course using data as part of that to help you see where you need to focus the most, you can lock in and really dedicate time and and have that care teams engaged,” Staggs said.