Advancing next-generation oncology alternative payment models in the COVID-19 era

New payment models, New regulatory and reimbursement approaches, Health system readiness
/ Healthcare

Optimal Oncology Alternative Payment Models, July 2020

COVID-19 prompted oncologists across the United States to rapidly deliver new interventions and policies to protect their patients and workforce. As the acute crisis abates in some states, stakeholders are contemplating the longer-term implications of COVID-19 on oncology. Such implications include the crisis’s impact on the ongoing shift to a value-based care paradigm and alternative payment models (APMs).

COVID-19 arrived when value-based oncology was already at an inflection point: the advent of a successor model to the country’s largest oncology payment reform experiment, the Oncology Care Model (OCM). This past fall, the Center for Medicare and Medicaid Innovation (CMMI) released a request for information describing the potential successor, the Oncology Care First (OCF) model, and CMMI’s vision to base aspects of the OCF model’s payment methodology on cancer type, a more granular approach than is used in OCM. Although the fate of the new model is uncertain following CMMI’s extension of OCM in response to COVID-19, the evolution of more granular payment models remains top of mind for participants in the oncology APMs advisory council, as do the underlying data foundations needed to achieve more granularity and accuracy.

Council participants met virtually in June 2020 to address the above issues and, specifically, the following:

  • The influence of risk stratification and predictive modeling on oncology APMs

  • How more granular clinical data can inform the design and payment methodology of APMs

  • Data repositories to support next-generation APM development

  • The effects of the COVID-19 crisis on APMs