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?
It is a little early, but the way the CMS program is set up, we compare ourselves [internally] as opposed to the outcomes from other cancer programs. We have already been doing this coordinated care and value-based care already, so in that sense comparing ourselves to ourselves can be more difficult than comparing us to other people. We are still analyzing a lot of the data, and we are still working with Integra Connect for that. The first part of that is submitting the data to CMS so they can give us back all the data, along with the claims data, to see how we can improve patient care. We don’t yet have results from year one.
You know, we have always thought about our patient care as value-based care anyway, and trying to give the best quality of care possible; that’s always number one for us. If we can minimize the cost, that’s great. We have already been doing a lot of this with Via Pathways, where treatment is standardized across all 25 sites of service. The way a chemotherapy regimen can get on Pathways is first efficacy and then side effects, and if both those two are similar between two regimens, then it’s cost. So it doesn’t matter if you go to Hillman Cancer Center in Pittsburgh or a Hillman Center at one of the outlying sites, such as Butler [Butler Health System Medical Oncology], where I am located.
What are your goals in the next 12 to 24 months as it relates to this initiative?
I would like to see some of our data and how we can analyze it on a population level to see which patients and which regimens are prone to hospitalizations, and see if we can try to minimize some of that to further improve patient care while lowering costs.
The program is great, and we were doing a lot of this already with Via Pathways, and part of that is Via Triage, too, where it standardizes patient symptom management. So if a patient calls in with nausea, if there’s a standardization regarding how to best manage that patient—and there are a lot of different symptoms with that—then not only can we provide the best patient care but we can also analyze that data for more informed decision making.