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UPMC’s March Forward in CMS’ Oncology Care Model

October 30, 2017
by Rajiv Leventhal
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The key has been breaking down data siloes for UPMC’s oncology patients, one leader says

In June 2016, nearly 200 U.S. oncology practices began participating in a new program launched by the Center for Medicare and Medicaid Innovation (CMMI) to encourage higher quality and more coordinated cancer care. The initiative from the Innovation Center, the Oncology Care Model (OCM), encourages practices to improve care and lower costs through episodic and performance-based payments that reward high-quality care.

Oncology practices at UPMC (University of Pittsburgh Medical Center) were among the selected participants, and one of the core issues that UPMC leaders needed to figure out from the get-go would be gathering new types of data and reporting it to CMS (the Centers for Medicare & Medicaid Services), as this presents a challenge to both the oncology practices and the health IT vendors who support their work.

As Healthcare Informatics Senior Contributing Editor David Raths wrote, shortly after CMS announced the model, “Practices participating in the OCM will provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy, with an emphasis on ‘person-centered’ care. They will provide enhanced services to beneficiaries who are in the OCM to help them receive timely, coordinated treatment. The five-year plan starts with bonuses only and then moves to an optional two-sided risk, starting in 2018.  (When it involves upside and downside risk, the program qualifies as an alternative payment model, and thus the participating oncologists would be exempt from MIPS requirements.)”

At UPMC, Rushir Choksi, M.D., an oncologist at the UPMC Hillman Cancer Center who is personally overseeing the OCM initiative for the health system, recently discussed the data gathering and care coordination issues at hand, as well as the core strategies that have been put in place to succeed in this initiative. Below are excerpts of that interview.

It’s been a little more than a year since CMS launched its Oncology Care Model pilot program. For your organization, what have been the biggest lessons learned so far?

I am the physician lead for the OCM model for our group, which has about 45 oncologists, and we are all participating in the model. Some of the biggest lessons learned [in year one] were trying to get the big data from multiple sources and then combining them to analyze the data—that has definitely proved difficult. So that’s why we partnered with Integra Connect [West Palm Beach, Fla.-based vendor with a platform that aims to help providers with value-based care programs].

Rushir Choksi, M.D.

What were the main goals you were looking to accomplish when you began in the pilot program?

The goal of the OCM in general is to provide more coordinated care for oncology patients, and also trying to provide care where patients need it—be it the hospital, office, or by phone, so we’re trying to help the patients in that way and satisfy them, and also improve coordinated care with other specialties. And we were doing a lot of this already. A lot of that work needs analysis—since each patient is different—so you need analysis on what stage of cancer the patient is, to the biomarkers, to the claims data, to other data that is on different platforms, and trying to get that all under one platform is difficult to analyze.

What were some of the high-level strategies your team has put in place?

Integra is helping break down a lot of our data siloes to make a unified platform so we can see the EHR [electronic health record], the claims data, the biomarkers for patients, the staging, and other data, so we can look at each piece of data individually and analyze it also on the population level to try to provide the best care that we can.

From a care coordination purpose, have your organization’s processes changed much compared to before this program, or was it more of the same of what you were already doing?

A lot of what we are doing in this initiative is what we have been doing for many years, especially with the coordinated care part of it. We have a lot of multidisciplinary clinics for oncology to treat the patient. We have UPMC Hillman Cancer Center Pathways [powered by UPMC subsidiary Via Oncology], a technology tool to try to standardize the care that we provide for each individual patient. It depends on the stage of cancer, what kind of cancer, and the biomarkers, so then we can have standardization. It doesn’t matter where you are because we have 25 sites of service. We have been doing all that for a very long time, and this just solidifies that what we have been doing is the right thing to do.

How are you specifically using data and analytics in this pilot program?


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