REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

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CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

###

CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is imprecise. If they say “A,” they mean “A,” so we need to understand it.

What impacts do you think the Medicare Part B demo will have on health plans, physicians, and patients?

Well, Medicare Part B, as I understand it, is a way to try to avoid the usage or over-usage of very expensive medications. I think ASCO has clearly stated the sentiment of oncologists that we do not believe that this is a good idea.

We think it’s counterproductive. It’s professionally insulting to suggest that we’re going to pick a more expensive medicine for our patients because we make more money on the margin of that medicine and not because it’s more efficacious. The fact is that most of the new game-changing, groundbreaking medications are expensive, so how do we use those medications—particularly if we’re doing buy-and-bill where we’re taking the risk of thousands of dollars or tens of thousands of dollars of inventory—for a $16 margin. No right-minded business person in the world would accept such an arrangement, so I just don’t understand this. This is where I think we’ve made a wrong turn. Our government has made a wrong turn.

As healthcare moves toward integrating data systems and eliminating silos, we still have clinics that haven’t made the transition even to an electronic health record (EHR). What do you think is the barrier?

Well, I think the principle reason why those have not gone to an EHR is probably going to be a combination of economics and logistics. It is expensive, and it’s not just the expense of purchasing the EHR, but the upkeep: the transition from paper charts to electronic charts, how it affects your billing and collection. And many physicians and offices and even some hospital systems, they’re at their limit of what they can handle. Their margins have been really compressed to very low numbers, so they don’t have a lot of time.

However, I think everyone realizes that the era of paper charts and paper medicine has come to a close. In order for us to coherently move into the era of precision medicine and payment reform, you’re going to have to have access to data. You have to be able to analyze data, and you have to be able to report back on the data you analyze, and the only way to do that is through an electronic record.

How important are value tools in today’s healthcare landscape? And do you think physicians—oncologists, in particular—are aware of the existence of these frameworks?

I think oncologists are aware of the existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value—value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value, like overall survival, progression-free survival, time to best response, incidence, and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value. They’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time, it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you, but there’s things that can keep you alive longer. So, those are all different scenarios where the value equation, the actual things we measure, are different. But in the context of everyone attempting to get to value, this isn’t the final state. The final state of value will be more in line with how other industries look at value, like Boeing or Apple. That’s where healthcare is going to ultimately wind up, but we’re not there yet.

Take Five with Terrill Jordan

Terrill Jordan is President and CEO of Regional Cancer Care Associates (RCCA).  He spoke to Symptoms & Cures about RCCA’s move toward value-based care in the field of cancer treatment.

We know CMS is trying to prepare physicians for far-reaching changes in the way the government will pay for medical care. You are participating in one of the few Alternative Payment Models that CMS has created as an alternative to the Merit-Based Incentive Payment System (MIPS). Not surprisingly, many physicians are confused by the changes ahead. Can you explain how this model works?

The Oncology Care Model (OCM) is a CMS Alternative Payment Model for outpatient oncology. There are approximately 200 cancer practices nationwide that are participating in the pilot, including RCCA. The OCM specifically seeks to redesign the way physician practices function and bring them more in line with value-based care. It is essentially creating oncology medical homes. Our practice redesign puts RCCA in a strong position to deliver value-based solutions that CMS, and the health care market generally, is expecting us to deliver. We are taking what started with health care reform generally — electronic medical records, an emphasis on quality and patient-centered care — and implementing it in the world of cancer care.

What is the role that data will play?

Data is critical. We always need to ask: Are we maintaining and improving the quality of care? And are we delivering value? We need data to ensure that quality is maintained and increases over time.  RCCA works with COTA and its proprietary software to use data to analyze decisions on the clinical level by examining the clinical outcomes associated with our care. This technology enables physicians to precisely classify specific types of cancer, down to its most basic molecular phenotype, and to provide insights on how various physicians are treating patients with the same profiles. A physician may evaluate his or her own data against other physicians and ask, “Do I need to change what I am doing to perform at the level other physicians in my field are achieving?”  In short, clinical decisions are informed by the data.

Everybody supports quality care. But how do you define and measure quality?

There are a number of thresholds CMS will use to measure quality in the OCM. Specifically, CMS has identified 12 performance measures. Since the care must be patient-centered, one measure is a survey of patient experience. Other quality metrics look at the quality of clinical care we must achieve for the more prevalent cancer diagnosis, including prostate, colon, and breast cancer.  CMS will also use claims data to look at ER visits, hospitalizations, and admissions to hospice. Interestingly enough, these three claims related measures have direct impact on the patient experience.  No cancer patient wants to visit the ER, get admitted to hospital, or continue on difficult therapy in place of valuable time with their families. When you reduce these unnecessary clinical encounters, you make the patient’s life better.

We are seeing a revolution in the way physicians will be paid and how they will be required to deliver care. Are physicians involved in cancer care ready?

Value-based reimbursement and true patient-centered care will present significant challenges for physician practices as currently configured. Creating an oncology medical home requires physicians to commit substantial time and resources and it is difficult to implement and operate in practice. In our case, RCCA is constantly analyzing, reviewing and refining our entire practice operations through various quality and clinical committees made up of both clinicians and administrators.  In fact, our quality committee meets bi-weekly. In addition, we regularly visit each office to exchange ideas about value-based reimbursement and clinical integration with clinicians and their staff . Specifically, we discuss how to implement a patient-centered oncology medical home. As you might imagine, this practice redesign requires ongoing and continuous dialogue among clinicians and administrators.

You are members of the Quality Institute. How does being involved with the Quality Institute support your work?

RCCA cannot deliver quality cancer care working solely within our oncologists’ offices. We must coordinate with primary care physicians and non-oncologic specialists. All of us must be on the same page in terms of quality. The Quality Institute helps RCCA coordinate with others who also see quality as paramount. The Quality Institute is giving us guidance about how to think about implementing quality across many specialties and is a significant resource for us.

CMS announces that RCCA has been selected for initiative promoting better cancer care

The Centers for Medicare & Medicaid Services (CMS) has selected Regional Cancer Care Associates (RCCA) as one of nearly 200 physician group practices and 17 health insurance companies nationwide to participate in a five-year care delivery model that supports and encourages higher quality, more coordinated cancer care for patients on Medicare.

The Oncology Care Model (OCM) is a patient-centered model designed to meet the dual missions of cancer care delivery system reform and the White House’s Cancer Moonshot Task Force. The model encourages collaboration and information sharing among a broader network of physicians, and it is intended to improve care and lower costs.

The OCM also encourages practices to improve care and lower costs through payment incentives. Under this model, physician practices receive performance-based payments for episodes of care surrounding chemotherapy administration to Medicare patients with cancer, as well as a monthly care management payment for each beneficiary.

Patrick Conway, MD, the CMS principal deputy administrator and chief medical officer, said that there has been higher than expected participation in the OCM among hospitals, indicative of the importance oncologists are placing on the program.

The OCM is a creation of the CMS’s Innovation Center, which focuses on fostering inventive solutions for issues in Medicare, Medicaid, and the Children’s Health Insurance Program, and is advanced by the Affordable Care Act. To read more, visit www.nj.com.

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

REGIONAL CANCER CARE ASSOCIATES AND AETNA FORM ONCOLOGY MEDICAL HOME

— The Patient-Focused Model Supports High-Value Care–

 

Hackensack, NJ, October 12, 2016 — Regional Cancer Care Associates (RCCA) and Aetna (NYSE: AET) announced a collaboration to create an oncology medical home that is designed to improve the care experience for cancer patients.

In the oncology medical home model, teams of cancer specialists collectively provide a patient’s health care when he or she has a cancer diagnosis. The model will give RCCA the responsibility to arrange appropriate care that is continuous and proactive and physicians will be incentivized for improved health, affordability and a better patient experience.

The oncology medical home arrangement will be available to patients at all RCCA locations in New Jersey and Maryland.

“RCCA is excited to partner with Aetna on this program. It aligns with our vision of providing patient centered care close to home,” said Terrill Jordan, RCCA President & CEO. “This partnership will not only enable us to continue the delivery of high quality care through reduced side effects, but will also facilitate cost effective care based on the data Aetna will be sharing,” said Michael Ruiz de Somocurcio, RCCA Vice President of Payer and Provider Collaboration.

The model is part of a strategic direction to transition from fee-for-service medicine to value-based payment. Value-based arrangements are emerging as a solution to address rising health care costs, clinical inefficiency, duplication of services, and access to care. In value-based models, doctors and hospitals are paid for helping to keep people healthy and for improving the health of those who have chronic conditions in an evidence-based, cost-effective way.

“We understand that cancer treatment can be the hardest experience that our members will ever have to go through,” said Daniel Knecht, M.D., M.B.A., Aetna’s Head of Strategy & Planning and Interim Head of Oncology Solutions. “This oncology medical home with RCCA will help provide our members with high-quality care and an optimal patient experience.”

The operating principles of the RCCA and Aetna oncology medical home include:

  • An orientation to the whole person. A personal physician from RCCA will be responsible for providing or arranging all of a patient’s health care needs with other qualified professionals. This includes care for all stages of treatment: preventive services, acute care, chronic care, palliative care and end-of-life care.
  • Evidence-based, personalized medical care. The RCCA team will focus on making treatment decisions based on current medical evidence for each unique disease presentation, patient-specific factors and patient choice using appropriate treatments to improve quality and outcomes.
  • Coordinated and integrated care. Care will be facilitated, across all elements of the health system, to enable Aetna members to get the appropriate care when and where it is needed and wanted, in a culturally and linguistically appropriate manner.
  • Quality and safety. Quality and safety will be a focus of care, including the use of evidence-based medicine, clinical decision support tools and accountability for continuous quality improvement.
  • Enhanced access to care. Care will be available through systems such as open scheduling, expanded hours and new options for communication between Aetna members, their personal physicians and hospital staff.

The oncology medical home arrangement launched in September 2016.

About RCCA

Regional Cancer Care Associates (RCCA), one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest-quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. RCCA includes 100 cancer care specialists and is supported by 700 employees at 27 care delivery sites, providing care to more than 23,000 new patients annually and over 230,000 existing patients in New Jersey, Maryland and Washington DC. For more information visit: http://www.RCCA.com.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com and learn about how Aetna is helping to build a healthier world. @AetnaNews

 

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CMS Value Model Doesn’t Do It All

Addressing the value changes that CMS is mandating takes enormous planning and study. Many oncology practices are grappling with the new programs that the government payer has asked them to adopt. Hackensack Meridian Health in New Jersey has joined the Oncology Care Model and is undergoing these same changes. We asked Andrew L. Pecora, MD, editor-in-chief of Oncology Business Management and chief innovation officer and president of Physician Services at the Hackensack center, to weigh in on these aspects of healthcare reform.

OncLive: Your oncology network, Regional Cancer Care Associates (RCCA), is participating in the OCM. Do you expect much of an impact on cost of care and clinical outcomes?

Pecora: The OCM put out by CMMI (The Center for Medicare & Medicaid Innovation) through CMS is a step forward in starting to think about value. Now, this is the first step, so this is not going to be transformative. We’re not measuring overall survival, progression-free survival, time to best response. We’re not measuring incidence and severity of toxicities. We’re not looking at whether or not the drugs cured people. We’re looking at something in between. Did you avoid unnecessary emergency department visits? Did you avoid unnecessary hospitalizations? Did you offer patients at the end-of-life access to palliative care instead of continued chemotherapy?

So, really, this is the first step to aligning the entire nation with a path of value. I believe there will be some savings, but not substantial. And I really don’t think we’re going to change true, hard-quality outcomes, except maybe a little. No one wants to go the emergency room if they don’t need it, and if you have an alternative— going to your doctor’s office because they’re open later—and you have a care coordinator who gets you in to see the doctor sooner—so that if you’re nauseous, you don’t wind up dehydrated and in kidney failure but in fact you get an IV—those are all good things. But that’s kind of snipping around the edges. It doesn’t go to the core: cancer is complex, the therapies are complex, outcomes are very variable, and how do we drive out that unnecessary variance?

Will the monthly enhanced oncology services (MEOS) payments be enough to cover your costs of implementing this program? How will the OCM pay for innovation?

Well, MEOS payments are strictly for care management, in essence. And I think probably they’ll be OK for care management. They’re not going to cover the cost of being innovative. They’re not going to cover the cost of doing clinical trials. They’re not going to cover the cost of care redesign. For basic care management—avoiding emergency rooms, navigating patients a little more smartly, steering patients to having end-of-life care discussions sooner than we do today—I think MEOS payments will do that.

How is the OCM going to transform operations and the focus at RCCA?

RCCA already has value embedded in itself because we’ve already been in value-based contracting. With Horizon, we’re doing bundles; with Cigna, we’re doing the Oncology Medical Home; with Aetna, we’re doing a version of the medical home; with UnitedHealthcare, we’re doing their plan. We already have this in our culture, so the OCM is not really going to change us all that much. But for most practices in the country, it will be a big step forward. Right now, the focus is a patient walks into the room, they have a problem, your job is to fix it. When they leave the room, it’s no longer your job, and patients get lost in that period of extended care. This will take it a step forward and project the oncologist, and their office into the additional portion of care.

What has been challenging about getting ready for the OCM?

I think the biggest challenge, for all of us, is figuring out what precisely does CMS want and how does it define things. It’s not clear yet. What we’re supposed to be reporting, certain definitions are not clear. But in fairness to CMS or CMMI, they haven’t made it clear yet. They’re still in the process of getting that done.

CMS Acting Administrator Andy Slavitt has expressed doubts about MACRA (the Medicare Access and CHIP Reauthorization Act (MACRA), which was supposed to be an improvement over the Sustainable Growth Rate (SGR) formula.

Well, getting rid of SGR is a clear improvement. MACRA and its implications, it’s just going to take a little more time. Here’s the fundamental problem: it sounds obvious, but it’s obviously not obvious. Doctors have a day job. They get up, it’s 5 in the morning, 6 in the morning. They have to go to work. They take care of—particularly in cancer—critically ill people. They’re lucky if they have lunch. Then they go home at night, and then they have families and lives and not a whole lot in between.

So, change at this level, where do you fit it in? It’s not like they are administrators where they can schedule meetings. A patient gets sick, someone shows up in the emergency room: “I can’t walk anymore!”; “I can’t move my arm!”; “I can’t breathe!” That’s medicine. I think that there’s a real lack of appreciation of that. Having said that, there’s nothing wrong with MACRA.

MACRA is the right way to go. It’s good to know that Andy Slavitt is thinking about maybe slowing it down a little—but you’ve got to get there. It’s a difficult thing. It’s not like the government has unlimited funds that they can say, “OK, doctors work half-time and put this in place, and we’ll take care of the rest of the patients.”

What feedback did Hackensack Meridian give CMS on this issue?

I think it’s more queries of what precisely do you mean here? How will this be measured? It was very—I don’t want to say very—there was some vagueness to it; not a ton, but some. CMS is a lot of things; the one thing it’s not is i