The Center for Medicare and Medicaid Innovation (CMMI) was formed as part of the Affordable Car Act and has been on the forefront of implementing and experimenting with new models of care delivery and payment. Considering the history of healthcare within a regulated environment a look at the sheer pace of innovative experiments that have been rolled out since the inception of CMMI is nothing short of remarkable. One such experiment was kicked off last summer, in line with other Center for Medicare and Medicaid Services (CMS) efforts within specialty healthcare, under the Oncology Care Model (OCM).
The other initiative with focus on specialty care for end-stage-renal-disease (ESRD) started last year under the ESRD Seamless Care Organization (ESCO) experiment. A close comparison of these two specialty care models brings to light how distinct they are. The ESCOs have a similar requirement as the Accountable Care Organization (ACO), where the nephrologist quarterbacks patient care as opposed to the primary care physician (PCP), along with a gain sharing incentive. In contrast, the OCM looks at a 6-month bundle around chemotherapy treatment along with addition cost-sharing incentives more closely resembling the Bundle Payments for Care Improvement (BPCI) experiments that CMMI has been running. The OCM lacks specification on how success would be measured and that has also caused some of the pioneers of alternate oncology care delivery models to back away from participation.
However, there is ambivalence around what effect the OCM will have on quality and cost breakdown of oncology care, and what kind of organization should be adopting this. If we look at the total cost of oncology care and divide that into medical oncology costs and in-patient costs the OCM is clearly setting its sights on lowering high(er) cost in-patient care and re-admissions, and work towards moving that to out-patient or community oncology care. This is absolutely the right place to focus on given the marginalization of oncology care in the outpatient setting over the last fifteen years.
Let's be clear that this would not address the growing cost of medical oncology that includes use and cost of drugs. This has been a hot button topic lately with the growing concern around branded medications, especially for high cost drugs, as well as heightened interest in oncology by big-pharma. Like a lot of other models proposed by CMS and CMMI, this would require evolution and a look beyond the low hanging fruit.