Through Networks, Collaboration Keeps Oncology Care in the Community

How can community oncology practices keep up with changing federal regulations and the constant fl ow of new scientific evidence, while delivering quality care in the era of payment reform?

The answer, said panelists during the final session of Patient-Centered Oncology Care^®, is to stay independent by working together. “Oncology Networks: Collaboration for Value-Based Care,” moderated by cochairman Kashyap B. Patel, MD, examined the growing role of practice networks in community oncology. The panel featured the following participants:

SIBEL BLAU, MD,

medical oncologist at Northwest Medical Specialties PLLC, and president and chief executive offi cer, Quality Cancer Care

Alliance (QCCA)

TERRILL JORDAN, JD, LLM,

president and chief executive offi cer, Regional Cancer Care Associates

BRAD PRECHTL, MBA,

chief executive officer, Florida Cancer Specialists (FCS) and American Oncology Network (AON)

ERICH MOUNCE, MSHA,

chief operating officer at OneOncology.

Blau noted that practice networks can take diff erent forms; QCCA, in fact, began as an alliance before members voted in February 2018 to become a clinically integrated network. Some collaboration models use a single tax identifi cation number; others have turned to private equity for investment in technology and infrastructure to fuel their transformation.

The bottom line, Blau said, is that collaboration helps practices stay independent while bringing certain infrastructure needs to scale. “The health-care system is changing. Value-based care is coming to our door, and we need to figure this all out,” she said. Jordan, of RCCA, which operates in New Jersey, Connecticut, and Maryland, said he takes a broader view of collaboration. “For value-based care, it means you actually include all the partners you work with,” he said. That would include payers, hospitals, and primary-care providers. Conversations with payers are much less hostile than they were 7 to 8 years ago.

“I think those deep community relationships, and the care we bring to those communities, is what will distinguish us,” he continued. “We think that’s how we’re going to grow.” A distinguishing feature of community oncology networks is their ability to operate across state lines while allowing practices to retain their local flavor. Community oncology networks operate with the practices front and center, which creates a different dynamic from a hospital buying out a practice. Prechtl, who is bringing the FCS model to 8 other states through AON, said there is often “pushback” when trying to collaborate with health systems, who are looking out for their own interests.

Mounce, who has been with the OneOncology network for a little over a year, said the arrival of new payment models, such as the Oncology Care Model (OCM), the Merit-based Incentive Payment System (MIPS), and models offered by commercial payers, makes collaborative networks essential for community oncology to survive and thrive. “Creating scale allows the culture to stay at the physician-practice level, which is a fundamental principle with OneOncology,” he said. “The issue is driving scale of economy and scale of intelligence across that platform,” while allowing for the nuances of individual practices and states.

Depending on the model, networks can work with practices at diff erent stages of the transition to two-sided risk. “There are some states that don’t even know what value-based care means,” said Mounce. “And then there are states that are very sophisticated … That’s why you let cultures survive across state lines.”

Patel asked Prechtl to discuss the challenges of moving into a new market that is unaccustomed to value-based care. “It’s going to take time to build size and scale within that state,” Prechtl said.

Health systems may even refuse to sign leases with practices in their medical offi ce buildings. “They immediately assume that there’s going to be some radical pulling out of services from the health system, instead of looking for the opportunity to keep those physicians community-based, keeping patients local, and growing the market share. But that’s what we’re experiencing when we go out of state.”

Patel also asked what lessons had been gained from the OCM experience. Small practices, Prechtl responded, have a difficult time with shared savings contracts in the OCM, which is why they look to organizations like AON to help manage the transition. Florida Cancer Specialists will move to two-sided risk in 2020.

“We’ve done very well under the OCM,” Prechtl said. “But, you know, there [were] a lot of good arguments where the OCM isn’t perfect. A lot of these practices defi nitely can use the sophistication of a large organization to help them.”

Jordan explained that the OCM is still a MIPS program, along with financing to make the transition. Regional Cancer Care Associates joined OCM with the idea that it would get some funds for making the shift to taking on risk and learning how to manage it. “Perhaps, a little naively, we thought we’d learn a lot more than we’ve learned. It’s been a little harder than we thought,” he said.

Groups outside the OCM that think they are avoiding the two-sided risk are not; it may just take a diff erent form, Jordan said. “All the learning that we’ve gained from OCM we apply across all our programs,” including the commercial value-based models. “So, overall, it’s been a great experience.”

Blau discussed the challenges of gaining fi nancing for the transition to value-based care, and Mounce said the new way of delivery care brings costs such as data scientists, whom no one had hired in the past. These are costs that can be shared across a network.

Jordan sees signs that the vendors who work with oncology practices aren’t interested only in large groups, they want to work with medium- and small-size practices, too. “What’s happening right now is we’re at the beginning of a journey, and it’s a journey that can be expensive when you start. And we don’t know where we’re going, and there’s a lot of change, so a small practice will have a hard time at the outset.”

In the long run, Jordan expects that both large and small practices will take part in care transformation; although that may make things complex, it will also help share the burden. “We’re going to fi nd out that’s an advantage,” he said.

Technology “is the great equalizer.”

Prechtl said he’s amazed that payers continue to pay higher reimbursement rates for hospital care than they do for community oncology, as hospitals “gobble up” community clinics only to drive up prices. “I just don’t understand how there’s not more of a focus on driving patients to community-based practices,” he said.

“Scale means everything,” Mounce said—and Blau agreed—and that happens when companies are managing the relationship between the payer and the oncologist. “Trust me, every payer in the country is trying to lower costs.”

Blau had her own thoughts on how to get there. “My practice is one of the top-performing practices of the OCM,” she said, and her group will be pursuing two-sided risk. “We’re very proud of it.”

But if the funding associated with the OCM goes away, things will change, and practices must fi nd “like-minded” partners with whom they can be clinically integrated, so that they can demonstrate how they are delivering value to a large group of payers. Otherwise, Blau warned, OCM-type models are not sustainable.

“We’re diff erent in many ways,” she said. “but we’re all trying to do the same thing.”

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