Alternative Payment Models in Cancer Care-The Future of Alternative Payment Model Participation

Video Transcription

Video Summary

The webinar focused on the future of oncology alternative payment models, especially the transition from the Oncology Care Model (OCM) to Oncology Care First (OCF). Speakers from ACCC and Avalere reviewed how value-based care has evolved over the past decade, emphasizing two major CMS strategies: bundled episode payments and total cost of care models such as ACOs.<br /><br />They explained that bundled payment models like BPCI and OCM have generally been viewed as successful because they improve care coordination, help practices manage risk, and can generate savings or at least maintain quality. However, participation has been limited, which is why CMS has increasingly relied on mandatory models such as CJR and the upcoming radiation oncology model.<br /><br />A major theme was the impact of COVID-19, which led CMS to reduce risk, ease reporting requirements, and delay model timelines. The speakers noted that the OCF launch is still uncertain, though it is expected to follow OCM without a gap because of the importance of maintaining infrastructure and MIPS implications.<br /><br />The discussion also covered OCM methodology challenges, including the trend factor, attribution rules, and the novel therapy adjustment. Avalere highlighted that OCM evaluation showed strong quality outcomes but a net loss to Medicare overall. Even so, speakers argued that practices have invested heavily in the model and that many still support a transition to OCF if reimbursement is adequate.<br /><br />Finally, they urged practices to assess financial and strategic value, volume thresholds, risk readiness, and data analytics capabilities. They also discussed direct contracting, reinsurance, commercial payer models, and the challenges faced by academic medical centers.

Keywords

oncology alternative payment models

Oncology Care Model

Oncology Care First

value-based care

bundled payment models

total cost of care

CMS strategies

COVID-19 impact

risk readiness

data analytics capabilities