WEST PALM BEACH, Fla. , July 14, 2022 /PRNewswire/ -- A leader in value-based, precision medicine, Integra Connect shares its perspective on the program and lessons from the Oncology Care Model
--Dr. Charles Saunders, CEO of Integra Connect
Integra Connect, LLC. is pleased that the Centers for Medicare & Medicaid Services' (CMS) Center for Medicare & Medicaid Innovation (CMMI) announced the next iteration of its value-based, oncology care model – the Enhancing Oncology Model (EOM). It's clear that CMMI is committed to advancing value-based, patient-centered cancer care and supporting provider and payer efforts to improve patient outcomes, while managing costs.
Integra Connect worked with approximately 1,500 oncology providers to drive their success in the Oncology Care Model (OCM), generating more than $200M in value-based care revenue and $50M in shared savings for our customers. In our experience, high-performing organizations used technology and insights to effectively manage hospital admissions, emergency department (ED) admissions, end-of-life expenses, and treatment decisions. Based on this experience, we are pleased that CMMI rolled several of these OCM program components into the EOM program, but also made strategic enhancements that will enable participants – regardless of their performance or participation in OCM – to find opportunities for improvement and growth, including:
- Diagnosis-specific target pricing: Oncology providers received a higher monthly enhanced oncology services fee (MEOS) under OCM, but the risk adjustment to determine target prices was based on a single price prediction model regardless of cancer type. This impacted the ability for practices to earn a performance-based payment (PBP) for in episodes with higher cost, more complex cancers.
Under EOM, target prices will be determined using cancer type specific price predictions, with CMMI setting pricing targets specifically for seven prevalent types of cancer, all commonly treated with systemic chemotherapy. These cancer types include breast cancer, chronic leukemia, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.
This is a positive change given that some cancer types are extremely complex and those patient cases require more time intensive interventions, enhanced support and services, as well as potentially more expensive treatments.
- Data availability: As part of OCM, CMS only sent claims data on a quarterly basis. Under EOM, practices can request the data be shared monthly. This increased transparency can help EOM participants by providing greater clarity on the episode attribution process – identifying patients who are most likely eligible for the program early on, and monitoring performance vs. the claims-based quality measures included in EOM.
- Benchmark pricing: With OCM, some practices found it difficult to compete against their own baselines-- or did not enroll in the program-- because they were already efficient. Benchmark pricing continues to be an important part of CMMI's oncology value-based care program, but under EOM, prices will not be based solely on a practice's own historical data – it added regional and national comparators to the experience adjuster that will be used to establish benchmark pricing. This is good news for high-performing organizations because it outlines how they can succeed and generate savings or performance bonuses based on those actions.
EOM also features new program components that reflect feedback from the industry, including: prioritizing health equity, understanding social determinants of health and using electronic patient reported outcomes (ePROs). While we don't yet know the impact of these actions, we believe that by making them a priority, EOM will play an important role in improving patient outcomes for years to come.
The EOM announcement was exciting, but not without controversy. Like others, we were surprised that CMMI introduced a lower MEOS payment under EOM, compared to OCM. However, upon further review, we believe that the change may create a smoother path towards shared savings, especially given the positive changes outlined above. Additionally, while we were not surprised by the inclusion of a two-sided risk model with stop loss and stop gain limits, we do acknowledge that this will be different for organizations, but also an imperative for those seeking to improve performance and impact provider behaviors.
As the industry awaits more information about the program, Integra Connect is evaluating ways to leverage our OCM experience, value-based care expertise, and technology leadership to help practices and payers succeed under EOM. For this reason, we will be hosting a webinar on August 3, 2022 at 3PM EDT/12PM PDT to provide insights on the program, how to evaluate your organization's readiness and capacity for EOM, and actions you can take now to succeed in 2023.
About our OCM Experience
Integra Connect supported OCM-participating oncology providers, practices, and payers for five years and across more than 200,000 patient episodes, representing one of the largest networks of OCM lives.
About Integra Connect
Integra Connect is a value-based, precision medicine company. While other companies may focus on one of these areas, Integra Connect's combined approach means providers, payers, and life sciences companies can harness value-based, precision medicine principles to improve their decision-making and make a difference in patients' lives.
Media Contact: Alyssa Howerton, +1.240.816.1645, [email protected]
SOURCE Integra Connect