The Oncology Management Summit

After CMS’ introduction of the Oncology Care Model, plans are now deciding whether to apply to pilot the program, adopt aspects of the model, or wait until more data is available on the structure and benefits of value-based cancer care. Evaluate different models of care to incorporate value-based care into a health plan oncology management strategy.

• Compare the structures of the Oncology Medical Home, ACOs, and Pathways Programs
• Examine the necessary changes (both internal and external) to adopt value-based payments for oncology
• Recognize key elements of a value-based model for oncology care

When plans and providers collaborate and share data, it is easier to keep track of patient outcomes and manage population health outcomes. Furthermore, the data sharing in these collaborations can better assist both parties in determining how payment structures should be shifted to share financial risks. Hear proven strategies for collaboration that give payers and providers a platform for exchanging key data and learning how to better manage an oncology population.

• Identify strategies for successful collaboration between payers and providers
• Determine how these partnerships help develop an infrastructure for shared risk and the development of alternative payment models
• Understand the importance of data sharing to better manage population health outcomes
• Discuss strategies for how partnerships can shift accountability and payments

Cancer therapy that is consistent with nationally recognized guidelines is a fundamental aspect of high quality cancer care, and is a core requirement of the Oncology Care Model put forth by the Center for Medicare and Medicaid Innovation. By partnering with third party vendors who help establish treatment pathways, physician practices and health plans can streamline the documentation and reporting of evidence-based clinical decisions. Hear about one physician-led initiative to implement third-party decision support technology for medical oncology pathways.

• Gain insight into an oncology practice’s approach to developing a pathways program and selecting a pathway decision support vendor
• Understand how pathways partnerships can improve coordination and quality of care
• Discuss the advantages of payer-provider collaboration in these initiatives under OCM-like reimbursement structures

The Center for Medicare and Medicaid Innovation developed the Oncology Care Model (OCM) and launched a pilot program to try and shift the way oncology care is managed in order to improve quality and minimize costs. Learn how this model can impact future payment structures and how the adoption of this model can impact the management of cancer care through the focus of an Integrated Delivery and Finance System, UPMC and UPMC Health Plan.

• Review the OCM and determine the main components followed in alternative models
• Discuss the cancers and outcomes the CMS Model is looking to evaluate and how these factors are addressed
• Analyze how the OCM will affect future oncology management strategies

It can be difficult to determine outcome measures that are reasonable standards for cancer care. In this session, discuss useful metrics that can be successful in evaluating the quality of care, and evaluate how certain measures apply to your own organization.

• Discuss outcome metrics that are measurable and specific to oncology
• Evaluate metrics that focus on patient outcomes and perception of care
• Describe data access opportunities and challenges

When looking at the total cost of care, the top 5% of patients with complex health care conditions will generate up to 50% of the health care costs. Oncology patients frequently qualify for this category of care needs. Learn how to integrate medical and behavioral health care management into the conversation with providers and address the patient’s social factors and health system determinants of care in order to fully address their needs.

• Analyze the value that integrated case management can bring to all stakeholders in managing oncology care
• Identify the basic steps of how to evaluate an integrated approach and incorporate it into practice
• Recognize the benefit from a clinical standpoint as well as the ROI for dedicating resources to an intentional and organized approach

When treatment is coordinated and care is streamlined, the quality of care is improved and unnecessary costs can be minimized. Hear how one plan is establishing a specialty medical home model with network oncologists and working collaboratively to address the health outcomes, total cost of care, and patient experience related to the treatment of cancer.

• Reduce overall expenditures by incorporating value-based payments
• Engage with quality and cost data to inform ongoing delivery system and payment reform
• Assist with the transformation of cancer care across the attributed population
• Decrease unwarranted variation in practice patterns through the use of evidence-based guidelines

High prices for cancer drugs can impact decisions around treatment and can burden patients with costly hospital bills. Learn how one plan focused on drug management strategies in order to minimize costs for multiple stakeholders.

• Outline strategies to enhance communication and expedite the prior-authorization process
• Illustrate ways to minimize costs by rewarding oncologists for high-value services and using pathways
• Collaborate with providers to understand side effects and drug costs that influence the choice of treatment regimens