ASCO Urges Multiple Cancer-Focused Alternative Payment Models, Proposes Medicare Demonstration that Uses Evidence-based Oncology Clinical Pathways

November 28, 2017

ASCO is urging the Administration to develop multiple oncology-specific alternative payment models (APMs) that will enable oncologists to select the optimal approach for their patients and allow their practices to successfully transition to a value-based payment environment.

In a letter responding to a Request for Information (RFI) by The Centers for Medicare and Medicaid Innovation (CMMI), ASCO acknowledges the shortcomings in the traditional fee-for-service Medicare program, but notes that CMMI’s Oncology Care Model (OCM) also has inadequacies. ASCO CEO Clifford Hudis, MD, FACP, FASCO, writes that “We urge CMMI to expand the opportunity for innovation beyond OCM’s framework and limited participation, offering all oncology practices a chance to innovate in ways that support the delivery of higher quality care at lower cost.  ASCO encourages CMMI to implement APMs that allow all practice settings—independent physician owned, academic, urban and rural, large and small—to participate and contribute to new approaches to cancer care delivery.” 

In its response, ASCO submitted a proposal for a new voluntary cancer-focused APM that would provide resources to better support the full range of services needed for oncology care planning and management, reduce unwarranted variation and cost by promoting evidence-based care, and organize reimbursement so that it works for a variety of care settings. ASCO estimates the proposed Medicare demonstration project will achieve a cost savings ranging between 5 to 30 percent per patient. 

Specifically, ASCO’s model would:

  • Use evidence-based clinical pathways for oncology. When properly developed, pathways provide an efficient, transparent, and nimble mechanism for safeguarding patients, controlling resource use, and accommodating rapid changes in scientific discovery. Adherence to clinical pathways would be a key metric for quality under the proposed demonstration.
  • Use meaningful performance measures. The demonstration requires practices to meet certain performance levels to achieve high-quality, evidence-based, and value-based care. Supplemental payments would be available for avoiding unnecessary hospital visits, adhering to pathways, and providing high quality of care to patient—including near the end of a patient’s life. Under this demonstration, practices will be subject to meaningful risk, but will be protected from unsustainable losses due to outliers.
  • Provide payments to support the full scope of services needed for high-quality patient care. Under ASCO’s model, practices would receive additional payments for initial patient evaluation, the development of treatment plans, care coordination, symptom management, and post-treatment/survivorship services to better reflect the range of oncology care.
  • Achieve significant cost savings. Even though oncology practices will receive supplemental payments, Medicare will achieve a net cost savings through reduced expenditures for chemotherapy, drug tests, imaging, and emergency department and hospitalization. Patients with Medicare will also see reductions in out-of-pocket costs during treatment.
  • Promote timely access and safe administration of oral cancer drugs. Oncology practices would receive support to manage the safe delivery of oral medications, and qualified physician practices would be recognized as in-network pharmacies by Medicare Part D and Medicare Advantage plans to reduce administrative burdens or excessive fees from pharmacy benefit managers (PBMs) or others.
  • Adopt shared savings with options for two-sided risk. In ASCO’s model, practices will be able to share in two-sided risk and will have a financial incentive to enhance the management of care for patients with cancer. Practices will be subject to meaningful risk, but will be protected from unsustainable losses due to outliers.
  • Increase emphasis on and flexibility of quality measures. Practices would be able to deploy and collect data from a large number of quality measures developed for oncology by ASCO..
  • Streamline data collection. Under the model, practices would reduce their documentation burden by reporting on pathway utilization, which provides important patient clinical data.

In submitting the Society’s proposal, Dr. Hudis notes that “the structure, approach, and design of APM models must focus on ways to control the costs of cancer care in the United States. At the same time, models must preserve and improve the ability of patients to obtain high-quality oncology services.”

Read ASCO’s response letter and APM proposal to CMMI.

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