ASCO Updates Its Oncology Medical Home Payment Model

Web Exclusives - Ovarian Cancer

The American Society of Clinical Oncology (ASCO) has released a major update to its Patient-Centered Oncology Payment (PCOP) model, an alternative payment model “designed to support transformation in cancer care delivery and reimbursement while ensuring that patients with cancer have access to high-quality, high-value care.”

ASCO stated that it submitted the updated PCOP model for consideration by the Physician-Focused Payment Model Technical Advisory Committee (PTAC). PTAC is an advisory group to the Department of Health & Human Services, which sends recommendations to the Secretary of Health & Human Services on stakeholder proposals for a type of alternative payment model known as a physician-focused payment model.

PCOP is an oncology-specific physician-focused payment model that aims to offer a solution in the transition from fee-for-service to value-based cancer care delivery. “Specifically, ASCO’s data show significant potential for PCOP to yield cost-savings—up to 8% across the healthcare system—while helping to ensure that patients have access to high-quality, high-value care,” ASCO stated in a press release.

PCOP is intended to be implemented in multidisciplinary networks of oncology providers and practices; federal, state, and private payers; employers; and regional health networks (known as “communities”), all of which are aligned to support patient-centered cancer care.

ASCO is taking 3 major approaches to transform cancer care:

  • Improved care delivery and coordination through an oncology medical home framework
  • A performance-based reimbursement system that relies on patient-centered standards and transitions to bundled payments
  • Consistent delivery of high-quality care using clinical pathways that adhere to ASCO criteria.

The support of PTAC and participation by the Medicare and Medicaid programs “would advance this model in its intent to establish communities of providers and payers working together to improve cancer care delivery,” wrote Clifford A. Hudis, MD, ASCO Chief Executive Officer, and Stephen S. Grubbs, MD, Vice President, Clinical Affairs, in the submission letter to PTAC.

The PCOP methodology is designed to evolve as a program progresses, as more data become available, and a community matures in its collaborative approach. Some components of the payment model are:

  • Use of monthly care management payments to support treatment planning, care management, and active monitoring
  • Performance incentive payments that are based on quality measurement, cost of care, outcomes, and adherence to evidence-based clinical treatment pathways.

Under the proposal, providers could enter 1 of 2 tracks. Practices who opt for Track 1 continue to receive fee-for-service reimbursement in addition to the care management amounts. Practice communities that choose to disrupt current fee-for-service reimbursement (Track 2) will participate in Consolidated Payments for Oncology Care (CPOC). Under this option, practices may elect to bundle either 50% or 100% of the value of specified services, and 90% of bundled amounts will be guaranteed under CPOC, whereas 10% of bundled amounts will be subject to the same performance adjustment as monthly performance incentive payments, times a 1.4 multiplier.

Performance transparency is a key goal of the model, with open sharing of cost-of-care data including provider access to detailed claims data and utilization figures. These cost-of-care data are meant to “assist providers and other stakeholders to identify opportunities to deliver high-value care, abandon low-value practices, and invest in a more efficient delivery system.”

The full oncology medical home model report can be found at:

https://practice.asco.org/sites/default/files/drupalfiles/content-files/billing-coding-reporting/documents/2019%20PCOP%20-%20FINAL_WEB_LOCKED.pdf.

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Last modified: April 27, 2020