CMS Public Listening Session: Potential Oncology Care First Model Part 1

CMS Public Listening Session: Potential Oncology Care First Model Part 1


>>GOOD MORNING, GOOD MORNING, GOOD AFTERNOON.
SORRY HAVEN’T HAD MY LUNCH YET. WELCOME EVERYBODY TO THIS LISTENING SESSION
ABOUT OUR FUTURE ONCOLOGY CARE MODEL WE HAVE SOMEBODY HERE WHO TOOK TIME OUT OF HER INCREDIBLY
BUSY SCHEDULE, THE ADMINISTRATOR, TO WELCOME TO THIS LISTENING SESSION, IT’S MEANS A BIG
TO HER, I AM A HUGE FAN, SHE’S SAVVY, SMART AND HELPED US PROGRESS HERE IN THE INNOVATION
CENTER, BRINGS NEW MODELS TO PLAY, HER SUPPORT HAS BEEN THE CURRENT ONCOLOGY CARE MODEL HAS
BEEN TREMENDOUS AND SHE’S BEEN VERY SUPPORTIVE OF US CONTINUING TO WORK IN THIS SPACE, SO
I HOPE YOU’LL JOIN ME IN WELCOMING HER FOR SOME OPENING REMARKS.
ADMINISTRATOR SEEMA, VERMA.>>WELL, GOOD AFTERNOON.
I HOPE EVERYBODY’S ADJUSTING WELL TO THE DAY LIGHT SAVINGS EXTRA HOUR OF SLEEP THIS MORNING.
WELL, FIRST OF ALL I WANT TO SAY THANK YOU ALL FOR JOINING US TODAY AND APPRECIATE THE
WORK YOU’VE ALREADY CONTRIBUTED TO THE ONCOLOGY FIRST MODEL.
TODAY’S LISTENING SESSION IS ABOUT THE NEXT CHAPTER IN OUR WORK ON VALUE AND CANCER CARE.
WE JUST PUT OUT AN RFI OUT LATE FRIDAY AFTERNOON SO I KNOW THAT MANY OF YOU HAVE NOT HAD AN
OPPORTUNITY TO GO THROUGH IT BUT THAT’S OKAY, THAT’S WHAT TODAY’S SESSION IS ABOUT, WE WILL
GO THROUGH SOME OF THAT WITH YOU. BUT THIS WILL NOT BE THE ONLY OPPORTUNITY
THAT YOU GET TO GIVE US YOUR FEEDBACK. THIS IS JUST HOPEFULLY THE FIRST OF MANY.
AGAIN I JUST WANT TO MAKE SURE THAT YOU ALL UNDERSTAND THAT WE APPRECIATE ALL OF THE WORK
THAT YOU DO. MANY OF YOU STARTED WITH THE ONCOLOGY MODEL
AND YOU WERE SOME OF THE FIRST IN THE NATION TO DO THIS TYPE OF WORK AROUND VALUE BASED
CARE. AS WE AND SO AS WE CRAFT THE NEXT VERSION
YOUR INPUT WILL BE VERY CRITICAL MOVING FORWARD. YOU KNOW AT A VERY HIGH LEVEL, I WANT TO MAKE
SURE PEOPLE UNDERSTAND OUR COMMITMENT TO VALUE-BASED CARE.
IF WE LOOK AT FROM THE LARGER VALUE OR LARGER LEVEL IF WE LOOK AT THE ISSUE, OF VALUE BASED
CARE AND HOW MUCH HEALTHCARE COSTS, ARISING AND WHAT WE’RE DOING TO ADDRESS THAT, WE KNOW
THAT HEALTHCARE COSTS ARE GOING TO GO TO ONE IN EVERY TYPH DOLLARS OVER THE NEXT SEVEN
YEARS, THAT’S WHAT OUR ACTUARS PREDICT AND THERE’S BEEN A LOT OF DISCUSSION ABOUT WHAT
THE SOLUTION IS, AND WHAT WE SHOULD DO, SOME FOLKS THINK THAT WE SHOULD HAVE MORE GOVERNED,
OUR SOLUTIONS ARE MORE ABOUT HOW DO WE ADDRESS THE UNDERLYING COSTS OF HEALTHCARE AND HOW
DO WE TRY TO ADDRESS THAT IN A WAY THAT KEEPS THE INNOVATIVE HEALTHCARE SYSTEM THAT WE ALL
KNOW AND APPRECIATE IN THE UNITED STATES SO WE WANT TO KEEP INNOVATION, WITH THAT BEING
SAID, WE ALL NEED TO WORK TOGETHER TO ADDRESS THE DRIVERS IN HEALTHCARE COSTS.
OUR ADMINISTRATION HAS BEEN ADDRESSING OR ADDRESSING THE ISSUE ON MANY DIFFERENT LEVELS
BUT ONE AREA IS VALUE BASED CARE AND THIS IS SOMETHING THAT DIDN’T START WITH OUR ADMINISTRATION,
IN FACT THIS HAS BEEN GOING ON FOR SEVERAL YEARS, IT’S BEEN SUPPORTED ON A BIPARTISAN
BASIS AND SO I THINK THERE’S WIDE SPREAD SUPPORT THAT THIS IS SORT OF WHERE THE HEALTHCARE
SYSTEM NEEDS TO GO, THAT WE NEED TO MOVE AWAY FROM A FEE FOR SERVICE SYSTEM INTO ONE THAT
PAYS FOR QUALITY AND PAYS FOR VALUE. SO THAT BEING SAID, OUR ADMINISTRATION HAS
BEEN FOCUSED NOT ONLY ON PUTTING OUT MORE MODELS, WE’RE LOOKING AT THE MODELS THAT WE
HAVE, WE’RE TWEAKING MODELS AND WE’RE ALSO PUTTING OUT NEW MODELS, AND A COUPLE PRINCIPLES
WITH THAT, WE WANT TO MAKE SURE THAT PROVIDER VS DIFFERENT PATHWAYS AND UNDERSTAND THAT
PROVIDERS ARE DIFFERENT PLACES, THAT BEING SAID WE WANT TO MAKE SURE THERE ARE OPPORTUNITIES
TO TAKE RISK, WHAT WE’VE SEEN FROM THE DAILY BASIS THEA THAT PROVIDERS THAT HAVE SKIN IN
THE GAME ACTUALLY HAVE BETTER RESULTS IN TERMS OF LOWING COSTS AND INCREASING QUALITY.
SO WE’RE GOING TO CONTINUE OUR WORK TO PUT OUT MORE MODELS, I THINK THE DISCUSSION YOU
WILL HAVE TODAY IN TERMS OF THIS MODEL, IS ACTUALLY REFLECTED IN A LOT OF DIFFERENT MODELS
THAT WE’VE BEEN PUTTING OUT. THE OTHER POINT THAT I WANTED TO MENTION IS
THAT OUR WORK AROUND VALUE BASED CARE IS NOT JUST ABOUT PUTTING OUT MORE MODELS, WE UNDERSTAND
THAT WE NEED TO DO A LOT OF WORK TO INCREASE THE ADOPTION AND PARTICIPATION IN VALUE BASED
MODELS. I HAD A CONVERSATION WITH SOME OF YOU RECENTLY
AND YOU TALKED ABOUT THE NEED FOR DATA AND HAVING MORE INFORMATION AT YOUR FINGERTIPS,
NOT ONLY AT THE BEGINNING WHEN YOU’RE HAPPENING ABOUT PARTICIPATING IN A MODEL, BUT AS YOU
ARE PARTICIPATING IN AD MODEL MAKING SURE HAVE YOU ACCESS TO REALTIME DATA SO I CAN
TELL THAT YOU CMMI HAS BEEN WORKING VERY HARD ON THIS AND WE ARE THINKING ABOUT WAYS WE
CAN PROVIDE MORE DATA ON A REALTIME BASIS. THAT’S ONE AREA, THE OTHER AREA WE’RE FOCUSING
ON ARE THINGS WE KNOW AFFECT VALUE-BASED CARE. AND THAT’S WHY WE’VE BEEN FOCUSED ON INTEROPERABILITY,
MAKING SURE THAT HEALTH RECORDS CAN MOVE WITH THE PATIENT AS THEY MOVE ACROSS THE SYSTEM
AND THAT SHOULD ALSO HELP DOCTORS FOCUS MORE ON VALUE BASED CARE IF WE CAN IMPROVE EFFORTS
AROUND COORDINATED CARE. THE OTHER AREA THAT WE’VE BEEN WORKING ON
IS OUR BIG INITIATIVE, PATIENCE OVER PAPERWORK BECAUSE WE WANT DOCTORS TO FOCUS ON PROVIDING
INNOVATIVE VALUE BASED CARE, WE KNOW WE HAVE A LOT OF WORK TO DO TO GET RID OF BURDENSOME
REGULATIONS AND WHEN PROVIDERS ARE PARTICIPATING IN VALUE BASED CARE, WE HAD THE OPPORTUNITY
TO PROVIDE THEM WITH WAIVERS OF SOME OF THE MEDICARE RULES AND THAT’S SOMETHING THAT WE’RE
LOOKING TO DO MORE OF, SO THAT AS PROVIDERS ARE TAKING ON MORE RISK, WE CAN PROVIDE THEM
WITH MORE WAIVERS AND I THINK YOU WILL HAVE A DISCUSSION OF THAT TODAY AS WELL.
I ALSO WANT TO TAKE THIS OPPORTUNITY TO TAKE–TO THANK THE MEMBERS OF PTAC THAT HAVE BEEN VERY
INSTRUMENTAL IN HELPING US DEVELOP ALL OF OUR MODELS, BUT IN PARTICULARLY THE ONES WE’RE
GOING TO–THE ONE WE WILL TALK ABOUT TODAY. SO HOPEFULLY, I’VE GIVEN YOU A LITTLE SENSE
OF OUR COMMITMENT TO VALUE BASED CARE AND OUR COMMITMENT TO WORKING WITH YOU.
WE APPRECIATE THE FACT THAT YOU’RE HERE TODAY, THE FACT THAT MANY OF YOU PARTICIPATE IN THESE
MODELS FROM THE ONSET, WE’RE LOOKING FORWARD TO THE NEXT GENERATION OF MODELS THAT WILL
HAVE OPPORTUNITIES OR MORE OPPORTUNITIES FOR PROVIDERS TO TAKE ON RISK WHICH WE THINK IS
A NECESSARY AND IMPORTANT DEVELOPMENT IN OUR EVOLUTION TOWARDS MORE VALUABLE-BASED CARE.
SO AGAIN THANK YOU. I’M GOING TO TURN YOU BACK OVER TO CHRIS RETIREDDER
WHO IS ONE OF OUR–RITTER, WHO IS ONE OF OUR BEST AT CMMI, SO THERE WILL BE PLENTY OF OPPORTUNITIES
TO HAVE INPUT SO THANK YOU VERY MUCH AND GOOD LUCK.
[ APPLAUSE ]>>I DON’T KNOW ABOUT SITTING OR STANDING,
I GUESS WE WILL SIT TO START. WELCOME, EVERYBODY THIS FEELS MORE FORMA THAT
WE HOPED IT WAS HARD TO FIGURE OUT HOW TO HAVE A BIG ROUND CIRCLE AND 127 PEOPLE IN
THE ROOM AND 734 PEOPLE ON THE PHONE OR WHATEVER IT MAY HAPPEN TO BE.
BUT THAT WAS OUR HOPE. THAT WILL GET TO HAVE THAT KIND OF A CONVERSATION
HERE BECAUSE I THINK IT’S REALLY IMPORTANT AS WE SET OFF ON THE NEXT FOOT TOWARD THE
ONCOLOGY CARE MODEL. THIS IS A SPACE THAT HAS SO MUCH STAKEHOLDER
ENGAGEMENT, THIS COMMUNITY IS NOT SHY. THAT’S REALLY IMPORTANT BECAUSE IT’S REALLY
IMPORTANT FOR EVERYBODY TO BE INVOLVED AS WE TRY TO FIGURE OUT HOW TO TAKE THESE NEXT
STEPS AND SO WE THOUGHT IT WAS REALLY IMPORTANT BEFORE WE KIND OF DID ANYTHING FINAL IN ANY
WAY, SHAPE OR FORM THAT WE GO AHEAD AND LET EVERYBODY HERE IN OUR BIG CIRCLE KNOW WHAT
IT IS WE’VE BEEN THINKING INTERNALLY ABOUT THE NEXT STEPS ON THE ONCOLOGY CARE MODEL,
THAT’S WHY WE PUT OUT AN RFI, THE TERM WE’VE BEEN USING INTERNALLY HAS BEEN ONCOLOGY CARE
FIRST, BUT EVERYBODY KNOWS THAT YOU KNOW THOSE NAMES CHANGE SOMETIMES QUITE A BIT, BEFORE
FINAL MODELS ARE ISSUED, SO IF YOU HEAR US USE THAT TERM, IT’S BECAUSE OUR INTERNAL LINGO
IS THERE, BUT WE DON’T WANT ANYONE TO GETTA CAUGHT UP AND THAT’S BEEN NAMED AND THEREFORE
IT’S A FINAL MODEL, THAT’S JUST HOUR WAY OF THINKING ABOUT WHATEVER IT IS THAT WE’RE WORKING
ON NEXT. WHAT YOU HAVE HERE IS WHAT WE INTERNALLY HAVE
SORT OF BEEN ABLE TO PUT TOGETHER AS THE STRUCTURE DEHIND OUR THINKING FOR THE NEXT VERSION OF
THIS MODEL AND IT’S NOT FINAL AND SO, THAT’S WHY WE WANTED TO SORT OF BRING IT FORWARD
AT THIS STAGE AND MAKE SURE EVERYBODY HAD A CHANCE TO REACT TO IT, TELL US WHERE WE’VE
GONE OFF THE RAILS, TELL US WHERE WE DIDN’T GO OFF THE RAILS, WE’RE WELCOME TO THOSE KINDS
OF COMMENTS AS WELL, HELP US UNDERSTAND WHERE MORE DEVELOPMENT IS NEEDED OR NOT NEEDED AND
WE’RE REALLY HOPING THAT THAT’S WHAT WILL COME FORWARD TODAY OUT OF THE QUESTIONS THAT
WE PUT OUT–IT WAS LATE, WE APOLOGIZE FOR THE FRIDAY READING AND I’M VERY SORRY, HOPEFULLY
IT’S NOT THAT LONG SO IT DIDN’T TAKE TOO, TOO, MUCH TIME AND IT’S NOT
LEGAL,–REALLY QUICKLY THEN I WOULD SIT I FEW GROUND RULES FOR OUR CIRCLE CONVERSATION,
EVERYBODY WHO’S HERE IN THE BUILDING IF YOU DON’T KNOW YOUR WAY AROUND THE HUMPHREY BUILDING,
I’M ASSUMING MOST OF YOU DO BUT THE RESTROOM IT IS ARE OUT THE DOOR TO LET LEFT, TO THE
LEFT, TO THE LEFT. SO THE PHONE PARTIC PLAN TO ANALYZE BY AGES,
SO THE LOVELY LADIES WILL LET US KNOW WHEN SOMEONE FROM THE PHONE WISHES TO SPEAK AS
MUCH AS IT’S NEVER FUN OR MAYBE IT IS FOR SOME OF YOU, I DON’T KNOW TO COME TO THE MIDDLE
AND USE THE MICROPHONE, THAT’S THE BEST WAY FOR US TO KNOW WHO YOU ARE, PLEASE SAY WHO
YOU ARE, WHAT YOU’RE REPRESENTING, WHAT YOUR COMMENTING ON, UNLESS IF IT’S NOT OBVIOUS,
SO THAT THE PHONES ON THE PHONE CAN HEAR FOR SURE.
WE WOULD LIKE FOLKS TO TRY AND KEEP THEIR REMARKS MODERATELY BRIEF.
I DON’T REALLY HAVE A TIME SET, BECAUSE I ALWAYS FEEL LIKE THAT GETS DIFFICULT BUT YOU
KNOW, DO YOUR BEST TO LET EVERYBODY ARE A CHANCE AT THE MICROPHONE IF YOU FEEL LIKE
YOU NEED TO SAY SOMETHING AND IF YOU WANT TO COME BACK AND SAY MORE, ALSO FINE.
I THINK THAT MAY BE BE IT FOR MY TALKING POINTS. I DID WANT TO SAY ONE OTHER THING.
THIS OF COURSE IS A LISTENING SESSION SO WE’RE NOT GOING TO BE IN THE BUSINESS OF–WE TOLD
YOU WHAT YOU THINK IT’S IN THE RFI, WE CAN CERTAINLY GIVE MORE INFORMATION IF THERE’S
SOME TO BE HAD ON THE THINKING THAT’S IN THERE, BUT I’M NOT SURE WE’RE IN A POSITION TO TALK
ABOUT A LOT MORE THAN WHAT’S IN THIS PAPER AND REALLY WHAT YOU HAVE IS NEED OF WHAT WE
HAVE, WE ARE HERE TO LISTEN TO SO SO I WANT TO SET THE GROUND RULE BEFORE WE GET UNDERWAY
AND ONE OTHER THING I WANT TO SAY WAS THE INNOVATION CENTER RIGHT NOW IS LOOKING AT
PUTTING UP ONE ONCOLOGY MODEL. WE KNOW THERE HAVE BEEN, MANY IN THIS NOT
SHY GROUP OF PEOPLE, OF DIFFERENT MODELS THAT HAVE BEEN PUT TOGETHER, THINKING THROUGH,
AND IT REALLY DEMONSTRATES THE CREATIVITY AND IMPORTANCE RIGHT OF THIS SPACE, WITH EVERYONE
THINKING THROUGH–WHAT IS THE BEST WAY IN MY PRACTICE OR WHAT I KNOW TO PUT THINGS TOGETHER
AND THERE ARE FOUR OR FIVE OR MORE VERY PROBUST MODELS OUT THERE, BROUGHT TOGETHER BY TREMENDOUS
THOUGHT LEADERS AND WE UNDERSTAND THAT AND IT’S ONE OF THE REASONS WE KNEW WE NEEDED
TO HAVE THIS LISTENING SESSION AND SO, I REALLY WANT TO SAY OUT OF THE GATE, THOUGH, WE’RE
REALLY LOOKING AT ONE MODEL. IT IS A HUGE UNDERTAKING AS I’M SURE EVERYBODY
WHO’S BEEN PARTICIPATE NOTHING OCM KNOWS, TO BRING UP A SINGLE MODEL AND THAT’S ONE
OF THE REASONS WE NEED TO HAVE THIS SESSION SO WE HAVE EVERYONE’S FEEDBACK AS WE GO FORWARD
SO WE CAN REALLY TALK ABOUT ALL THE PIECES THAT GO ALONG WITH IT.
ANY COMMENTS ON THAT? GREAT.
I FEEL LIKE WHEN I USED TO TEACH AND I WOULD BE LIKE WHO HAS AN ANSWER?
AND NOBODY WANTED TO RAISE THEIR HAND. SO LET’S START WITH A REVIEW OF WHAT’S ACTUALLY
IN THE RFI, JUST IN CASE, YOU DIDN’T MAKE IT YOUR EARLY SATURDAY MORNING READING LIKE
SOME PEOPLE. DO YOU MIND RUNNING THROUGH IT.
>>HI, ERCH I’M LAURA STRAWBRIDGE, I WANT TO–I HOPE YOU DON’T MIND CHRIS TO DO A CIBOL
BACK UP AND IMPOSSIBLE TO BUILD ROWS BECAUSE I’M NOT SURE THAT EVERYONE IN THE ROOM KNOWS
WHO ALL THREE OF US ARE SO CHRIS JUST LAUNCHED US IN, LET’S WASTE NO TIME BUT I’M LAURA STRABRIDGE
I’M THE DIRECTOR OF DIVISION PAYMENT AMBULATORY PAYMENT MODELS WHICH INCLUDES ONCOLOGY CARE
MODEL AND PROPOSED RADIATION ONCOLOGY MODEL AS WELL AS SOME OTHER WORK, TOO.
CRIT NASAA.COM RITTER IS MY BOSS, PATIENT CARE MODELS GROUP AT CMMI, THAT IS PART OF
HER GROUP AND SO SHE IS VERY WELL AWARE OF THE WORK THAT’S BEEN DONE IN OCM TO DATE.
AS PART OF HER PORTFOLIO. AND THEN HILLARY CAVANAUGH ON MY LEFT, YOU’RE
RIGHT, IS CURRENTLY THE LEAD OF OUR EFFORTS AROUND THINKING ABOUT THE ONCOLOGY CARE FIRST
MODEL. SO WE’RE ALL REALLY, REALLY HAPPY TO SEE YOU
ALL HERE IN PERSON TODAY AND THOSE OF YOU JOINING US ON THE PHONE AS WELL, I DO WANT
TO NOTE, WE WILL BE TURNING TO THE PHONE FREQUENTLY, SO, DON’T WORRY, HOPEFULLY EVERYONE WILL GET
A CHANCE AND PLEASE DO SUBMIT WRITTEN COMMENTS. IN TERMS OF THE MODEL I’LL TRY TO BE BRIEF
AS SOME OF YOU KNOW WHO ME WELL KNOW I CAN TALK AND ON AND ON SO I WILL TRY NOT TO DO
THAT BUT HAPPY TO TALK MORE ABOUT ANY OF THE THINGS COVER INDEED THE RFI IF FOLKS HAVE
QUESTIONS ONER WANT CLARIFICATION, IF YOU HAVEN’T HAD A CHANCE TO READ IT YET AND WHAT
I SAY DOESN’T QUITE MAKE SENSE. ONE OF THE KEY THINGS WE’VE BEENINGING ABOUT
AS WE THINK ABOUT A MODEL THAT MIGHT COME AFTER OCM IS TRYING TO PREVENT ANY GAB IN
TIMING, SO, AS WE’VE BEEN THINKING ABOUTORS CM, IT’S LAST EPISODES WILL BEGIN AT THE END
OF 2020. SO WE’VE BEEN THINKING ABOUT A MODEL WHERE
THE POTENTIAL START WOULD BE THE BEGINNING OF 2021.
WE ARE CONTINUING TO THINK ABOUT THIS POTENTIAL OCS MODEL AS A MULTIPAYOR MODEL.
THERE ARE PAYORS IN THE AUDIENCE TODAY, WE WANT TO HEAR YOUR FEEDBACK BUT MANY OF YOU
IN THE ROOM KNOW NAIN OCM RIGHT NOW WE HAVE A NUMBER OF PAYOR PARTNERS AND THOSE PAYORS
HAVE GROWN THEIR PARTICIPATION OVER TIME IN TERMS OF THE NUMBER OF PRACTICES THEY PARTNER
WITH AND WE WANT TO KNOW HOW WE CAN HELP PAYORS TAKE THE NEXT STEP WITH US.
SO HOPING TO HEAR FEEDBACK ABOUT THAT. WE–IN TERMS OF CARE TRANSFORMATION, I WANT
TO SAY UP TPROBT AND THIS WILL ECHO WHAT YOU HEARD FROM THE ADMINISTRATOR PATIENTS ARE
AT THE CORE OF THIS MODEL. WE WANT BETTER QUALITY CARE FOR PATIENTS AND
WE HOPE THAT AT THE SAME TIME COSTS ARE MAINTAINED OR REDUCED AS OUR OVERALL MANDATE BUT WE REALLY
HAVE A LOT OF THOUGHTFUL CONVERSATIONS AROUND HOW WE CAN PUSH ONCOLOGY PRACTICES IN THE
U.S. TO MOVE BEYOND THE INCREDIBLE GAINS–I’LL SPEAK FOR MYSELF, BELIEVE ARE BEING MADE RIGHT
NOW IN OCM, WE ARE ON AN ROUTINE BASIS AND WE HOPE THIS PANS OUT IN EVALUATION REPORTS
THAT CARE REALLY HAS CHANGED AS A RESULT OF OCM AND SO WE’VE BEEN THINKING A LOT ABOUT
HOW DO WE MOVE EVEN FURTHER BEYOND THAT SO WHAT WE DESCRIBE IN THE RFI IN TERMS OF WHAT
WE CALL CARE TRANSFORMATION, IT’S THAT THE REQUIREMENTS OF OCM IN TERMS OF HAVING 24/SEVEN
ACCESS TO CARE, CARE NAVIGATION, CARE PLANNING, ALSO USING CERTIFIED ELECTRONIC HEALTH RECORDS,
DAILY BASIS THEA QUALITY IMPROVEMENT, ALL OF THOSE ACTIVITIES WE CONTINUE BUT WE WOULD
LIKE TO ADD AN ADDITIONAL ACTIVITY WHICH HOPEFULLY WON’T BE SEEN AS A BURDEN BUT RATHERRA AS
AN OPPORTUNITY. THE EVIDENT IS REALLY EMERGING AROUND ELECTRONIC
PATIENT REPORTED OUTCOMES, AND SO, OUR INTENT IS TO HAVE IN THIS MODEL POTENTIALLY PARTICIPANTS
START TO GRADUALLY IMPLEMENT EPROS OVER TIME AS PART OF THEIR WORK STREAMS.
SO WE WOULD LOVE TO HEAR FROM YOU ALL ABOUT WHETHER THAT’S AN OPPORTUNITY, WHETHER THERE
ARE OTHER AREAS IN CARRIER TRANSPORTATION WE SHOULD BE PURSUING AND THEN WE COME TO
THE PAYMENT PERIOD, I WILL DO THIS BRIEFLY BUT WE CAN GO IN MORE DETAIL AS THE AFTERNOON
GOES ON. THERE ARE TWO KEY COMPONENTS THAT WE’RE ENVISIONING
FOR THE OCF PAYMENT METHODOLOGY, ONE WOULD BUILD OFF THE EXISTING PERFORMANCE BASED PAYMENTS–IT
WOULD BE TOTAL CARE RESPONSIBILITY WE DON’T DESCRIBE
IN THE RFI ANY EXCLUSIONS TO THAT, SO THAT MEANS DRUGS WOULD BE INCLUDED JUDGE UTV TO
BE VERY CLEAR AND WE DO NOTE A WAY IN WHICH WE’RE THINKING ABOUT THIS A LITTLE DIFFERENT
THAN IN OCM AND I WANTED TO POINT OUT A COUPLE OF THEM AND I MAY MISS A FEW SO HILLARY OR
CHRIS CAN JUMP IN BUT ONE IS WE’RE THINKING DIFFERENTLY ABOUT ATTRIBUTION, WE’VE HEARD
THAT APWRAOUBGZ IS AICAL TOEFRPLG PREDICT SO WE’RE LOOKING AT WAYS TO MAKE IT MORE PREDICTABLE
AT THE OUTSET OF AN EPISODE OF CARE AND REDUCE SOME OF THE DELAYS THERE, SO WE’RE THINKING
FOR CASES WHERE AN ONCOLOGY PRACTICE PROVIDES THE INITIATING CHEMO THERAPY THEY WOULD BE
ATTRIBUTED, THE EPISODE AS LONG AS THEY PROVIDE AT LEAST A QUARTER THEM THEM DURING THE SIX
MONTH EPISODE. THAT MEANS AS LONG AS YOU HIT THAT QUARTER
THRESHOLD, NOT A PLURALITY, AS LOCK AS YOU HIT THE QUARTER, YOU WOULD BE ATTRIBUTED THAT
EPISODE, WE’VE DONE LOOKING AT HOW THAT ADISTRIBUTION WOULD MATCHUP TO CURRENT ATTRIBUTION METHODOLOGY
AND WHERE THESE ARE BELIEVING THAT WOULD REPRESENT AN IMPROVEMENT.
WE ARE ALSO LOOKING AT OTHER CHANGES LIKE DROPPING SOME OF OUR LOW RISK CANCERS OUT
OF THE TOTAL COST OF CARE RESPONSIBILITY. THAT’S SOMETHING THAT WE HAVE ALSO HEARD FROM
FOLKS IN ADDITION TO ABUTION AS BEING PROBLEMATIC. SO SPECIFICALLY PROSTATE, BREAST AND BLADDER,
LOW RISK CANCERS WOULD NOT BE PART OF THE TOTAL COST OF CARE RESPONSIBILITY.
WE ARE LOOKING AT THINGS IF WE WANT TO GO SUPER IN THE WEEDS AND I KNOW SOME OF YOU
WILL HAVE COMMENTS THAT ARE VERY WEEDY AND WE LOOK FORWARD TO THEM, THINGS LIKE, DOING
THE TREND FACTOR, POTENTIALLY AS A CANCER TYPE LEVEL, RATHER THAN AT THE PRACTICE LEVEL
AS WE DO CURRENTLY, DOING NOVEL THERAPY ADJUSTMENTA THE CANCER LEVEL, FOLKS HAVE PUBLISHED AND
HEALTH AFFAIRS AND ELSEWHERE AS THOSE KINDS OF TOPICS IN THOSE NOTES SO WE HAVE LISTENED
TO YOU ON THAT. SO SOEZ ARE SOME OF THE THINGS THAT WE’RE
THINKING ON THE PERFORMANCE BASED SIDE OF THINGS WE ARE THINKING THAT IN TERPS OF RISK
THAT PRACTICES THAT HAVE BEEN IN OCM, WOULD BE REQUIRED TO BE IN DOWN SIDE RISK FROM THE
BEGINNING OF A POTENTIAL FUTURE, ONCOLOGY CARE FIRST MODEL SO WE WOULD LIKE SOME FEEDBACK
TODAY ON MOW WE MIGHT DEFINE RISK. WE ARE THINKING WE WOULD HAVE ONE RISK TRACK
WITH MINIMAL RISK AND ONE RISK TRACK WITH A LOT MORE RISK ON THE TABLE FOR THOSE WHO
HAVE THE APPETITE FOR IT. ONE OF THE THINGS WE PUT IN THE RFI IF YOU
GOT THAT FAR IS THAT WE ARINGING ABOUT THE DEFINING RISK AND THE STOP LOSS AS A PERCENT
OF THE EPISODE BENCHMARK, THOSE IN OCM KNOW WE HAVE OFFERED AN ALTERNATIVE RISK ARRANGEMENT
WHERE RISK IS DEFINE INDEED PRACTICE REVENUE, AND WE’VE HEARD A NUMBER OF MULTISPECIALTY
PRACTICE IN PARTICULAR THAT THAT DEFINITION IS PROBLEMATIC FOR THEM SO WE’RE LOOKING AT
WAYS TO HAVE MINIMAL RISK ON THE PERCENT EPISODE BENCHMARK AS OPPOSE TO REVENUE.
SO VERY QUICKLY PWAOUZ I’M GETTING LOOKS LIKE I’M TAKING LONG, ON THE PAYMENT, IT WOULD
BE A MONTHLY PAYMENT MADE PROSPECTIVELY TO PARTICIPATING PRACTICES AND THEIR–I’LL CALL
THEM PARTNERING HOPDPDS TO THE EXTENT THAT A PRACTICE ADMINISTERS DRUGS IN THE HOSPITAL
OUTPATIENT SETTING WE WOULD ASK THAT THOSE OUTPATIENT HOSPITAL DEPARTMENTS COME INTO
THE MODEL FOR THE MONTHLY POPULATION PIECE OF THINGS, THERE ARE DETAILS IN THERE THAT
WE CAN TALK THROUGH IF THAT’S OF INTEREST. THIS PAYMENT WOULD BE ORIENTED AROUND REPLACING
THE REGULAR FEE FOR SERVE BILLING, AND DRUG ADMINISTRATION SERVICES, AND ALSO WOULD INCLUDE
PAYMENT FOR ENHANCEMENT SERVICES SIMILAR TO OCM BUT WOULD NO LONGER REQUIRE PRACTICE,
I HOPE THOSE OF YOU FROM OCM NOTICE THAD AND LIKE THAT WE HAPPENING THAT THE ASSIGNMENT
OF PATIENTS AND THIS MONTHLY PAYMENT WOULD BE MORE REDETECTION ANTIBODYIBLE, ANYONE WHO
HAS A CANCER ENM AS AN ONCOLOGY PRACTICE WOULD BE ASSIGNED TO THE PRACTICE.
THERE WOULDN’T BE GUESS WORK THERE AND YOUR ENHANCED SERVICE PAYMENT WOULD COME TO YOU
AS PART OF A PROSPECTIVE PAYMENT. THERE WOULD BE A RECONCILIATION ON THE BACK
END IF YOUR VOLUME OR CASE MIX OF PATIENTS THAT YOU SEE OVER TIME CHANGES BUT WE WOULDN’T
ADJUST THAT PAYMENT IN TERMS OF VOLUME AND INTENSITY OF SERVICES.
SO IT’S REALLY, THE GOAL IS TO TRY TO MOVE BEYOND OCM WHICH IS BUILT OFF A BACKBONE OF
FEE FOR SERVICE INTO A MODEL THAT WOULD FREE ONCOLOGISTS UP FROM BEING CONCERNED ABOUT
THE NUMBER OF ENMS THEY PROVIDE OR DRUG ADMINISTRATION SERVICES THEY PROVIDE AND KNOW THERE’S A PREDICTABLE
AND PERSPECTIVE PAYMENT THERE. SO I WILL PAUSE AND SEE WHAT I FORGOT.
>>I THINK THAT WAS A GOOD OVERVIEW, I THINK THE ONLY THING I WOULD ADD IS IN TERMS OF
QUALITY STRATEGY, WE ARE THINKING OF USING QUALITY MEASURES CURRENTLY IN OCM, I THINK
WE SEE A LOT OF ROOM FOR IMPROVEMENT WITH THOSE MEASURES WE WANT TO MOVE FORWARD WITH
THAT STRATEGY AND THEN ALSO IN TERMS OF TWO SIDED RISK, THOSE TWO TRACKS WOULD QUALIFY
AS AN ADVANCE–AS AN APM. AS WE’RE CURRENTLY ENVISIONING IT IN ITS POTENTIAL
FORM RIGHT NOW.>>OKAY, THAT WAS A LOT, EVERYONE READY?
SO I THINK THE FIRST QUESTION WE HAVE IS REALLY ABOUT THE PRACTICE TRANSFORMATION AND LOOKING
AT UNDERSTANDING HOW ANY–THIS PROPOSED MODEL OR AREAS CAN SUPPORT PRACTICE TRANSFORMATION
AND PRACTICE DESIGN ACTIVITIES AND IS THERE ANYTHING THAT WE CAN LEARN BOTH FROM THIS
EXPERIENCE AND EVERYONE ELSE’S EXPERIENCE IN TERMS OF ADDITIONAL PRACTICE, REDESIGN
OR CHANGES IN THE DESIGN ACTIVITIES THAT WE CURRENTLY HAVE LISTED?
AS LAURA SAID THE BIG CHANGE WE HAVE HERE FROM OUR OCM EXPERIENCE IS THE E-PRO PROPOSAL.
HOWEVER, I KNOW FOLKS HAVE DONE A LOT OF STUFF OUTSIDE OF OCM AS WELL, SO WE’RE OPENING THAT
UP FIRST. WE WOULD LOVE TO GET COMMENTS ON THAT IF FOLKS
HAVE THEM.>>STATE WHO YOU ARE AND WHERE YOU’RE FROM.
>>THEY’RE ALL FREAKING OUT.>>I’M NOT.
>>I’M [INDISCERNIBLE] EXECUTIVE DIRECTOR OF COMMUNITY ONCOLOGY ALLIANCE AND I JUST
WANT TO ACTUALLY AN OVERVIEW CHRIS BEFORE ANSWERING THAT AND I WILL BE BRIEF BECAUSE
LAURYNN AND I SHARE SOMETHING, WE BOTH LIKE TO TALK A LOT.
AS YOU ALL KNOW SERIOUSLY, AND OTHERS MAY NOT NOT KNOW BUT WE ARE BIG PROPOSENTS OF
CMMI, OF THE OCM, THE OCM TEAM HAS BEEN GREAT. I DON’T SAY THAT JUST BECAUSE I USUALLY SAY
IT LIKE IT IS, YOU KNOW? BUT IT’S BEEN GREAT AND WE’VE ACTUALLY REALLY
ENJOYED THE RELATIONSHIP. I KNOW AND YOU GUYS DON’T HAVE TO COMMENT
AT ALL, SO I’LL COMMENT FOR EVERYBODY THAT YOU WOULD LIKE TO GET THIS OUT WAY BEFORE
FRIDAY AFTERNOON. POWERS THAT BE, BASICALLY IT IS WHAT IT IS.
SO, GOT IT OUT THERE. WHAT I WOULD SAY IS, THAT NUMBER ONE PUSH
BACK THE DATE OF THREE WEEKS BECAUSE IT’S UNREASONABLE, GIVEN IT CAME OUT FRIDAY AFTERNOON
TO BASICALLY HAVE ONLY THREE WEEKS FROM TODAY TO PROVIDE YOU COMMENTS, AND IF YOU HAVE ANY–IF
WE HAVE ANY COMMONALITY, YOU WILL DO ME PERSONALLY A BIG FAVOR BECAUSE WE HAVE A TWO-DAY MEETING
ON THURSDAY FRIDAY BEFORE THAT SERIOUSLY THAT WE HAD SET UP ALREADY, SO IT’S VERY FORTUITTOUS
THAT A LOT OF PRACTICES REPRESENTED HERE, A LOT OF PRACTICES, ARE ACTUALLY MEETING FOR
TWO DAYS ABOUT NOT ONLY THE OCM 2.0 MODEL BUT IT WILL NOW BE ABOUT THIS SO TO SPEND
THE WEEKEND WHICH MY WIFE BECAUSE WE HAVE 20 PEOPLE COMING FOR THANKSGIVING HAS TOLD
ME, DO NOT DO ANYTHING THAT WEEKEND, IT’S MINE, IT WILL HELP MY MARRIAGE TOO IF WE’RE
NOT SITTING AROUND TRYING TO WRITE A COMMENT LETTER THOSE TWO DAYS.
SO ON A VERY SERIOUS NOTE. I KNOW IT WAS PUSHED BACK BUT IF YOU REALLY
WANT THOUGHTFUL COMMENTS, PLEASE PUSH THAT BACK.
AND WHOEVER NEEDS TO BE TALKED TO AT THE WHITE HOUSE, ASK ME, I WILL HELP, NOT THAT THEY
LISTEN TO ME. THE OTHER THING I WOULD SAY IN ALL SERIOUSNESS
IS AS YOU GUYS KNOW AT THE END OF MAY, WE SENT A LETTER TO YOU ADDRESSED TO ADAM BOWLER
ABOUT SOME OF THE PROBLEMS WITH THE UCM, AND AS YOU KNOW THE LETTER SAID WE WANT TO MAKE
AS VERY POSITIVE BUT THERE ARE ISSUES RELATED TO ABUTION, NEW NOVEL THERAPY BUT THEN LIST
TIMELY REPORTING AND THE ONE THING THAT’S A LITTLE FRUSTRATING, YOU MET WITH US RIGHT
AWAY, BOW HAS BEEN TALKING TO ALEX AND TEAM, I KNOW YOU TALKED ABOUT INCORPORATING SOME
OF THAT AND BY THE WAY FOR ANYBODY, THIS IS UP ON THE COA WEBSITE, IT HASN’T ALL BEEN
ANSWERED SO IT’S A LITTLE WHEN YOU’RE DEVELOPING A NEW MODEL AND YOU SAY TRUST ME, WE’RE FIXING
SOME OF THIS, I THINK SOME OF THE PROBLEMS HERE EVERYBODY KNOWS ABOUT, IT WOULD BE VERY
HELPFUL TO SORT OF HAVE A LITTLE TRANSITION OF WHAT THAT LOOKS LIKE AS WELL, TOO.
SO I WOULD SAY, IN THAT THAT’S REALLY IMPORTANT AND THE LAST POINT THEY WANT TO MAKE IS AND
I KNOW IT HAS TO BE DONE TO SATISFY THE LAWYERS FOR WHY YOU’RE DOING THE MODEL IN 1115A OF
SECTION 1115A OF THE ACA BUT WHEN YOU SAY THINGS LIKE, THE INENTIOUS FICIENCY AND VARIATION
IN ONCOLOGY CARE AND THERE ARE TWO STUDIES THAT ARE SO DATED YOU DO A DISSERVICE FOR
WHAT YOU JUST SAID LAURA BEFORE WHICH IS PRACTICE TRANSFORMATION THE THING IS THE OCM HAS TRANSFORMED,
I SEE IT AT A PATIENT LEVEL, I SEE WHAT PRACTICES HAVE DONE, I WAS AT A PRACTICE TWO WEEKS AGO
LOOK BEING AT THIS, SO I KNOW YOU HAVE TO LIKE QUOTE THINGS TO SAY THIS IS WHY WE’RE
DOING THE MODEL BUT THAT CAN TELL WHOEVER THAT NEEDS TO BE IT NEEDS TO BE DROPPED BECAUSE
IT’S COUNTER PRODETECTEDDIVE TO THE GREAT STRAYEDS THAT HAVE BEEN MADE, I COMMEND YOU
GUYS, I REALLY DO BUT PLEASE, PLEASE PUSH BACK THE COMMENT DATE SO WE GET REAL GOOD
COMMENTS AND I IMPLORE YOU TO GIVE SOME RESPONSE TO THIS OR LET US KNOW LAWN MOWER’S BEING
FIXED HOW IT’S BEING FIXED TO GET A GOOD FEELING AND AND AGAIN, THANK YOU VERY MUCH.
THANKS FOR HAVING US.>>SORRY JUST WHILE SARAH’S COMING UP, HIS
COMMENT MADE ME REMEMBER SOMETHING I FORGOT TO SAY EARLIER IN TERPS OF THE RFI, ONE OTHER
THING WE’RE WORKING HARD AT FIGURING OUT AND THIS AGAIN, ALIGNS WITH THE ADMINISTRATORS
EARLIER REMARK SYSTEM HOW TO GET TIMELY DATA TO PARTICIPANTS IN THIS FUTURE MODEL SO RIGHT
NOW WE’RE ENVISIONING THAT IT COULD BE SOMETHING THAT WOULD HAPPEN ON A MONTHLY BASIS AS OPPOSE
TO WHAT YOU ALL KNOW IN OCM, SO JUST WANTED TO NOTE THAT.
[ APPLAUSE ] ALSO VOLUNTARY AS CURRENTLY ENVISIONED.
>>WE WANT IT TO BE MANDATORY. CANNED LAUGHTER.
>>HELLO. SO I WANTED TO COME UP BEFORE TED STOLE ALL
OF OUR THUNDER. SO, ONE THING THEY WANT TO–
>>CAN YOU IDENTIFY WHO YOU ARE AND WHO YOU ARE WITH.
>>SORRY, HOURA KNOWS ME, I AM SARAH [INDISCERNIBLE] WITH THE FLORIDA ONCOLOGY SPECIALIST NETWORK.
SO I CURRENTLY MANAGE TWO GROUPS WITHIN THE ONCOLOGY CARE MODEL FROM A PRACTICE TRANSFORMATION
STANDPOINT, I THINK CONTINUING ON THE PATHOLOGY MEASURES THAT ARE CURRENTLY SET ARE FANTASTIC.
WE PUT A LOT OF INFRASTRUCTURE AND TECHNOLOGY VENDORS ARE HERE THAT I HAVE DONE THAT AND
CONTINUING TO BUILD ON THAT IS A WONDERFUL THING.
SO THAT’S FROM OUR PRACTICE IS A PERSPECTIVE OF A VERY, VERY STRONG THING TO CONTINUE ON.
BECAUSE WE SEE THE SAME OPPORTUNITIES AS WELL TO CONTINUE AND THAT TAKES A LOT OF TIME,
YOU KNOW ESPECIALLY WITH JUST THE WAY MARKETS CHANGE IN THE COMMUNITIES.
IT’S SOMETHING THAT IS GOING TO TAKE MORE THAN PROBABLY FIVE YEARS TO DO.
SO I COMMEND YOU FOR THAT. ONE THINK THIS I WOULD ASK, CAN YOU ELABORATE
FURTHER ON THAT ADDITIONAL ELEMENT, THE EPRO THAT YOU ARE LOOKING TO ADD, I THINK THAT
WOULD BE HELPFUL FOR US TO BE ABLE TO COMMENT FURTHER ON THAT.
SO THAT WE WILL UNDERSTAND MORE HOW TO REACT TO IT.
I THINK THAT WAS JUST A BIT VAGUE TO BE ABLE TO COMMENT ON THAT FURTHER.
IT SOUNDS LIKE A GREAT CONCEPT BUT WOULD LIKE MORE INFORMATION ON IT.
>>I THINK THE CONCEPT OF AN E-PRO IS SOMETHING WE’RE LOOKING AT AND LAURA I CAN CERTAINLY
COMMENT, I DON’T KNOW THERE’S A PARTICULAR TRAOUPLT OR ANYTHING THAT’S BEEN COMMITTED
TO IT AT THIS MOMENT IN TIME.>>WE PURPOSELY LEFT IT AVAILABLE IN THE RFI
BECAUSE WE WANT TO HEAR FROM YOU ALL WHERE THE FIELD IS NOW, WHAT IT WOULD TAKE TO START
IMPLEMENTING EPROS, WHAT, YOU KNOW WOULD BE THE RIGHT KIND OF RAMP UP OVERTIME, WHAT TOOLS,
YOU THINK ARE GOOD ONES TO USE, I THINK ANY OF THAT IS ON THE TABLE WHETHER OR NOT IT’S
THE RIGHT DIRECTION TO GO. WE THINK THAT THE STUDIES DONE SO FAR ARE
PRETTY EXCITING AND COULD POTENTIALLY REINFORCE A LOT OF OVERALL GOALS WE HAVE FOR THE MODEL
BUT REALLY LOOKING FOR FOLKS TO GIVE THEIR THOUGHTS AROUND HOW WE COULD STRUCTURE THAT
IN A WAY THAT WOULD NOT CREATE A LOT OF BURDEN RIGHT OFF THE BAT OF THE START OF A MODEL.
>>THE OTHER THING I WILL NOTE ABOUT EPROS IS THAT WE–THERE’S ALWAYS ISSUES OF HOW MUCH
THE COLLECTION OF THE INFORMATION WE’RE GETTING FROM THE PROS AND SOME OF THIS IS A COMFORT
LEVEL FOR THE PROVIDERS AND SOME OF IT IS KIND OF WHAT WE–THE VARIABILITY OF WHAT WE
COLLECT IN THE INSTRUMENT SO I THINK A LO OF THESE TECHNICAL DETAIL WE NEED TO HAVE
THE CONVERSATION HOW MUCH WILL THAT ADJUST THE PAYMENT.
WHAT ARE PEOPLE COMFORTABLE WITH, WHAT IS AN APPROPRIATE SCALE IN TERMS OF GETTING THE
EPROS INCORPORATED, BECAUSE HAVING THAT PATIENT VOICE IS REALLY IMPORTANT BUT I THINK WHERE
PEOPLE’S COMFORT LEVEL WITH THAT IS WE WOULD LIKE TO BED IT, PEOPLE WHO HAD SUCCESS WITH
IT, WHAT THEIR VIEWS ARE THERE, BECAUSE I KNOW WHEN WE GET INTO PROS IT’S A VERY DIFFERENT
CONVERSATION THAN WHEN IT’S SOMETHING, I THE PRACTICE CAN TAKE CARE OF, RIGHT?
I CAN MAKE SURE I DID MY CARE PLAN, MAKE SURE THIS HAPPENS, I CAN’T CONTROL ALWAYS WHAT
THAT PATIENT IS GOING TO PUT DOWN ON THE PRO, IT’S REALLY CRITICAL OBVIOUSLY TALKING TO
THE PATIENT IS THE MOST IMPORTANT THING THAT HAPPENS IN THIS MODEL.
AMONG OTHER THINGS, RIGHT SOME SO GETTING THOSE NUANCES REALLY IMPORTANT, YEAH.
>>THANK YOU. SO DR. [INDISCERNIBLE] FIRST OF ALL WE WANT
TO THANK YOUAL ARE BEING WONDERFUL JOB FOR WORKING WITH US IN [INDISCERNIBLE] TREATMENT
EXPERIENCE OF SEEING PATIENTS CARE TRANSFORMATION. I’M ALSO WHEN I SAW SOME OF THE ELEMENTS,
I CAN SEE YOU ARE LISTENING TO US ABOUT THESE NEW MODELS SO THANK YOU ONCE AGAIN FOR THAT.
THE E-PRO, SO ANOTHER CONCERN I HAVE IS I HAVE A LOCATION AND SOME OTHER LOCATION.
HALF OF MY PATIENTS CHOOSE [INDISCERNIBLE] FORM, SO IF IT’S GOING TO DO WITH SOMETHING
NOT AT THE POINT OF CARE, IT MAY BE HARD FOR PATIENT LIVING IN NEW MEXICO, ALABAMA, SOUTH
CAROLINA, OR MAYBE GEORGIA TO BE ABLE TO REFLECT BECAUSE THEY’RE ONLY–THEY STILL USE THE FORM,
AND JUST TO GIVE AN EXTREME EXAMPLE, I HAVE A PATIENT WHO I’VE BEEN SEEING FOR 15 YEARS
HE BROUGHT THE FORM FROM CMMI, I GIVE YOU ONE ON ALL THE PARAMETERS.
[LAUGHTER] SO THIS–
>>[INDISCERNIBLE]>>SO, I THINK–WHAT I THINK IS THAT THE EDUCATION
LEVEL AND THE TRUST LEVEL MAY BE DIFFERENT IN DIFFERENT PARTS OF THE COUNTRY AND ON THAT
NOTE, I JUST WANT TO BRING ONE MORE THING THAT’S STILL NOT PART OF THE E-PRO IS ARE
YOU LOOKING AT ADDING THE GEOGRAPHY AND SOCIAL, ECONOMIC KIND OF VARIATION IN THE CARE BECAUSE
THAT COULD BE HUGE VARIATION IN PATIENTS WILLING TO ACCESS ON THE SPOT CARE.
>>SO WHY DON’T YOU TALK A BIT ABOUT THAT, IF YOU’RE ABOUT THE SES COMPONENTS OF OF THAT
INTEREST.>>IT DOES BECAUSE IN MY ROLE OF LOCATION,
THERE ARE PATIENT WHO IS DON’T HAVE A TRANSPORT, THEY LIVE 3040-MILES IN A SMALL MOBILE OR
TRAILER HOME AND EVEN FOR NAUSEA, THEY WILL CALL 911.
WE TRY TO DO EVERYTHING POSSIBLE. WE ARE LOOKING AT HIRING THE NURSE PRACTITIONER
TO GO TO THEIR HOME TO CHECK ON THEM BUT THESE ARE VERY DISABLED THAT DEVELOPMENTAL ENDOCRINOLOGYIATE
PERFORMNESS IN SPITE OF US OPENING OUR CLINIC [INDISCERNIBLE] SO I’M NOT SURE HOW TO SOLVE
IT BUT I THINK BARBARA MAY HAVE AN IDEA ABOUT–WHY DON’T YOU HEAD UP THERE.
[LAUGHTER]>>THANK YOU DR. [INDISCERNIBLE].
>>THANK YOU BARBARA REPRESENTING MASON I WAS GOING TO LISTEN FOR A WHILE FIRST BEFORE
I SPOKE. SO YES SOCIAL DETERMINE IN FACTS ARE HUGE,
IF A PATIENT DOESN’T HAVE A CAREGIVER OR TRAPEZIUS PORTATION AND THEY GET SCARED IN THE MIDDLE
OF THE NIGHT OR DAY, THE EASIEST WAY TO GET TO CARE IS TO CALL 911 AND IT TAKES A LARGE
AMOUNT OF WORK TO TRY TO MITIGATE SOME OF THAT.
FOR ELECTRONIC PATIENT OUTCOMES. I THINK WE DISCOVERED IN THE 86 QUESTIONNAIRE
THAT YOU SENT OUT, I WOULDN’T DO AN 86 QUESTION QUESTIONNAIRE AND I’M HEALTHY AND I THINK
THAT THAT’S TO BE DONE ELECTRONICALLY AND AT THE POINT OF CARE AND WE THINK THAT THE
ELECTRONIC TRIAGE PATHWAYS WE CAN USE CAN REALLY QUANTIFY THE SIDE EFFECTS OF VARIOUS
REGIMENS AND QUANTIFY THE PATIENTS REACTION TO THOSE THINGS.
I THINK THAT’S A VALUABLE PART. AS I DID SPEND MY WEEKEND READING.
YOUR PROPOSAL AND I CAME–>>SORRY.
>>IT’S QUITE ALL RIGHT. IT’S SORT OF WHAT I DO AND I CAME TO THE CONCLUSION
AS I READ THIS THAT IT’S BUILDING STRONGLY ON WHAT WE’VE DONE WITH OCM AND THE PRACTICE
TRANSFORMATION PART BUT THE MORE I READ IT, THE MORE I FEEL THAT YOU ACTUALLY NEED MASON.
AND YOU NEED THAT BECAUSE PURE GOING TO TAKE THE PREVIOUS COST OF CARE OF A LARGE GROUP
OF PATIENTS AND USE THAT AS A PAYMENT METHODOLOGY TO GIVE US THIS ADVANCED PAYMENT AND THEN
TRUE IT UP AT THE END. AND IF THERE’S ONE MODEL THAT MAKES IT SO
IMPORTANT THAT WE GET IT RIGHT, WE HAVE TO GET IT RIGHT BECAUSE THE END GAME OF THIS
IS THAT THERE’S STILL 40% OF AMERICANS WHO LIVE IN AREAS SERVED BY SMALL AND INDEPENDENT
PRACTICES WHICH ARE THE LOW COST HIGH QUALITY SIDE OF SERVICE AND IF WE PUT A MODEL FORWARD
THAT THEY CAN’T SURVIVE IN, AND THEY END UP EITHER GOING OUT OF BUSINESS AND COA HAS HUGE
AMOUNTS OF DATA THIS, GOING OUT OF BUSINESS OR SELLING TO HOSPITALS WE DIMINISHED ACCESS
COMPLETELY OR WE DOUBLE THE PRICE. AND I SHARE YOUR CONCERNS ABOUT AMERICAN HEALTHCARE
KIND OF GOING OFF THE CLIFFS IN TERMS OF COSTS. WE CANNOT SPEND 20% OF OUR DOLLARS ON HEALTHCARE.
SO WHAT WE REALLY NEED IS TO AVOID THAT SCENARIO OF AN END GAME.
WE NEED TO HAVE AN ACCURATE COST AND THAT’S WHEN’S LACKING, WE KNOW WHAT CHARGE, WE KNOW
WHAT WE PAID, WE KNOW THERE’S DIFFERENT LEVELS OF CHARGES DEPENDING ON HOW MUCH MARKET SHARE
SOMEBODY HAS WHETHER THEY’RE HOSPITAL BASED OR POSITION FEE SCHEDULE BASED, THERE’S A
HUGE AMOUNT BUT WE DON’T KNOW WHAT OTHER INDUSTRIES ALL KNOW WHICH IS WHAT DOES IT TAKE TO HAVE
SOMEBODY IN AN EXAM ROOM OR INFUSION CHAIR OR LINEAR ACCELERATOR FOR THAT PERIOD OF TIME.
SO WHEN I READ THIS I THOUGHT, WHAT I NEED TO PLEAD WITH YOU GUYS TO DO IS TO LET ME
GRAB SOME OF THE PEOPLE WHO CAME OUT LIKE ACENSURE AND CARDINAL AND CONCERTO HEALTH
AND USE THEIR TEAMS OF DATA SCIENTISTS WITH THIS GROUP OF PRACTICES CALLED NCCA WHICH
DOES INCLUDE CASH OUT THAT ARE WILLING TO GIVE CLINICAL DATA.
WE’VE SET IT UP SO THAT WE CAN SCREEN SCRAPE THE DATA TO BE ABLE TO GET NOT JUST WHAT’S
IN THE CLICKABLE FIELDS ABOUT YOU THAT REALLY IMPORTANT DATA THAT’S NOT IN THE CLICKABLE
FIELDS. SO THAT WE CAN ACTUALLY TAKE THE CLAIMS DATA
AND CLINICAL DATA AND FIGURE OUT THAT VARIATION AND FIGURE OUT WHAT WE CAN TROLL SPECIAL WHAT
IS REHAILED TO AN UNDERLYING PATIENT ISSUE, CO-MORBIDITIES.
FACTORS THAT ARE CANCER RELATED, FACTORS THAT ARE SOCIALLY RELATED AND BEING ABLE TO REALLY
COME UP WITH AN ACCURATE PRICE BECAUSE IF WE CAN GET AN ACCURATE PRICE IN ONCOLOGY,
THEN WE CAN DO IT IN SUCH A WAY WE CAN CONTROL A MAINLIOR DRIVER OF HEALTH CARE COSTS IN
THE COUNTRY AND WE CAN EXPAND IT TO OTHER SPECIALTIES.
AND WE CAN DO IT IF WE DO IT IN THE WAY THAT INVOLVES THE MASON PROCESS WHERE WE’RE WORKING
WITH NCCN WHICH IS THE GOLD STANDARD FOR QUALITY OF CARE AND THE QUALITY OF CARE I’M TALKING
ABOUT IS DO I KNOW THE RIGHT THING TO SELECT FOR THIS PATIENT IN FRONT OF ME.
DO I KNOW THE REST TEST TO ON ORDER, THE RIGHT DRUGS TO GET, DO I KNOW WHEN THEY NEED RADIATION
AND WHEN THEY NEED SURGERY AND IF WE CAN DO THAT AND PULL ELECTRONICALLY THE DATA FOR
THAT CLINICAL QUALITY AND THEN YOU WILL KNOW IF I CREATE SAVINGS I DIDN’T DO IT BY SKIMPING
ON CARE. I DID IT BY VERY EFFICIENTLY MANAGING SO IF
WE WILL GET TO BUNDLE WHICH IS WHAT YOU’RE WORKING ON WITH THE ONCOLOGY CARE FIRST PROCESS,
IT IS SO COO USUAL TO HAVE ACCURATE COSTS SO AS YOU’RE WORKING THIS THROUGH, WE HAVE
A YEAR BEFORE IT STARTS. I THINK WE HAVE TO RAMP UP THE DATA SCIENTISTS
AND WE OUGHT TO REALLY LOOK AT THE ACCURATE COSTS OF CARE AND WE OUGHT TO TAKE THAT MODEL
AND EMBED IT INTO WHAT YOU’RE DOING BECAUSE IT WILL ONLY MAKE IT MORE ACCURATE AND A WHOLE
LOT STRONGER.>>OKAY, SO THOSE SOUND LIKE SOME REALLY GOOD
COMMENTS ON WHERE MASON METHODOLOGIES COULD BE LOOKED AT FOR SUPPORTING THE SAME PIECES,
AM I CORRECT? NYES?
I WANT TO MAKE SURE THAT WE BOTH ACKNOWLEDGE THAT UNDER THE PAYMENT CONVERSATION AND I
WANT TO MAKE SURE THAT I ASK YOU IF THERE’S ANYTHING MORE IN THE E-PRO OF PRACTICE DESIGN
SPACE THAT WE SHOULD LOOK AT TO MAKE SURE I DON’T CLOSE OUT THIS ISSUE WITHOUT EXTRICATING
THAT.>>WITH THE ELECTRONIC–I AGREE WITH CACHA’S
COMMENTS, YOUR CELL COVERAGE DEPENDS ON WHETHER YOU’RE ON THE TOP OR BOTTOM OF THE MOUNTAIN
AND PEOPLE THE AVERAGE INCOME AND $16,000 AIER, THEY’RE NOT GOING TO BUY AN IPHONE.
SO HAVING THEM TRY TO ELECTRONICALLY FIGURE THAT OUT AND WITH THE HUGE QUESTIONNAIRE,
A LOT OF MY PATIENTS SAY I GOT THIS THING IN THE MAIL, I THROUGH IT AWAY.
BECAUSE LITERACY IS SUCH AN ISSUE THERE. SO TRYING TO GET IT ELECTRONICALLY WILL REQUIRE
THAT THE PRACTICES DO THIS AT THE TIME OF CARE AND IT IS EXPENSIVE TO HAVE A STAFF MEMBER
SIT THERE AND TRY TO EXPLAIN TO A PATIENT QUESTION BY QUESTION, WHAT DO THEY MEAN?
LET ME GIVE YOU AN EXAMPLE FROM YOUR PREVIOUS SURVEY, YOU SAID DID YOUR DOCTOR PROPERLY
CONTROL YOUR PAIN, YES OR NO? WELL IF THEY HAD NO PAIN DO THEY SAY YES BECAUSE
I DIDN’T HAVE ANY PAIN SO IT WAS CONTROLLED OR DID THEY SAY NO BECAUSE I DIDN’T HAVE TO
HAVE IT CONTROLLED. AND THEN THERE WAS NO NOT APPLICABLE.
SO A LOT OF THESE DIFFICULTIES WE SAW WITH THE SURVEY, WILL REQUIRE A LOT OF ONE-ON-ONE
INTERACTION WITH THE PATIENTS BECAUSE THESE ARE SICK PEOPLE.
THEY’RE GOING TO HAVE A TOUGH TIME DOING ANY OF THIS PAPERWORK, WE DO SURVEYS ON PATIENTS
ALL THE TIME AND ONE OF THE COMMON RESPONSES I GET IS PLEASE STOP DOING SURVEYS ON US.
THEY’RE SURVEYED TO DEATH.>>OKAY.
THANK YOU.>>SO [INDISCERNIBLE] I REPRESENT THE U.S.
ONCOLOGY NETWORK NTHERE WAS A NICE GENTLEMAN IN THE BACK–
>>AARON CAN ALWAYS GO FIRST.>>[LAUGHTER]
>>SO A COUPLE OF THINGS, THE ELECTRONIC PROS, COMLITELY
AGREE WITH YOU THAT IS THE WAVE OF THE FUTURE AND SOMETHING WE NEED TO BE WORKING TOWARDS
I COMPLETELY AGREE WITH THE COMMENTS MADE ALREADY THAT THAT IS EXPENSIVE AND THAT IS
TAKEN INTO ACCOUNT IN THE ENHANCED SERVICES PAYMENTS TO MAKE SURE THAT WE AS A PRABTIS
CAN PROPERLY’M ELEMENT EPROS BECAUSE IT IS EXPENSIVE.
YOU ARE LOOKING AT PARTNERING WITH ANOTHER TECHNOLOGY VENDOR, JUST DOING IT IS NOT ENOUGH,
YOU HAVE TO TAKE THAT INFORMATION AND MAKE IT APPLICABLE TO THE PARTY AND CHANGE WHAT
YOU’RE DOING WITH THE PATIENT BASED ON THAT INFORMATION.
SOY JUST MAKING SURE WE’RE ABLE TO DO THAT WOULD BE HELPFUL AND RECOGNIZING THE COST
OF THAT SERVICE BUT I DO THINK THAT IF WE ARE APPROPRIATELY COMPENSATED FOR THAT, THAT
IS SOMETHING WE SHOULD MOVE FORWARDS BECAUSE THAT IS WHERE STUDY VS CLEARLY SHOWN THAT
WE NEED TO BE HEAD HEAD.>>CAN I ASK ARE YOU DOING IT ALREADY?
>>WE ARE CURRENTLY IMPLEMENTING IT.>>OKAY.
>>WE HAVEN’T DONE IT YET BUT WE’RE WORKING ON IT.
THE OTHER QUESTION I HAVE ABOUT THE PAYMENT METHODOLOGIES IS WE’RE STILL TALKING ABOUT
THAT, ONE. QUESTIONS HI, WE’RE GETTING A MONTHLY PERSPECTIVE
PAYMENT BUT YET WE’RE ATTRIBUTING PATIENTS BASED ON ENM SERVICES, SO I’M ASSUMING WE’RE
STILL BILL LIKE WE WOULD HAVE, NOT REIMBURSED FOR THAT IS THAT THE CORRECT, ONE OF THE QUESTIONS
I HAVE AND I ACTUALLY AM NOT THOROUGHLY OPPOSED TO WHAT’S MORE OR LESS A CAPITATED MODEL WHERE
WE GET A PERSPECTIVE PAYMENT FOR THE SERVICES WE PROVIDE, ONE OF THE QUESTIONS I HAVE IS
HOW DO YOU INCORPORATE THEN, IN WHATEVER WAIVERS WE MAY BE ABLE TO GET TO TRULY THINK ABOUT
HOW WE PROVIDE CARE DIFFERENTLY, VERSES THE WORLD WHERE WE I CAN POTENTIALLY HAVE OTHER
STAFF COME IN TO DO SERVICES THAT MY PHYSICIANS MAY BE PROVIDING NOW, THAT WILL ENHANCE SERVICES
TO BE PROVIDED BUT NOT NECESSARILY BILLABLE ENM EVENTS HOW DO YOU TAKE THAT INTO ISSUESA
COUNT AS WE LOOK AT CHANGING THE PAYMENT MODELS MOVING FORWARD BECAUSE THERE IS OPPORTUNITY
THERE TO CHANGE THE WAY THAT WE MANAGE PATIENTS, OUTSIDE OF THE FEE FOR SERVICE WORLD.
WHEN I THINK ABOUT THAT, THINK ABOUT PSYCHOTHERAPY AND ACTIVITIES AND PROJECTS KHE IS NOT COVERED
NOW. THINKING ABOUT SOCIAL WORK SUPPORT WHICH IS
NOT COVERED NOW. ENHANCING NURSING SERVICES WHICH ARE NOT BILLABLE
NOW, WHICH IS THE NINES 0211 WHICH NOBODY EVER BILLS.
YOU KNOW HOW ARE YOU GOING TO INCORPORATE THE POTENTIAL CHANGES THAT PRACTICE MAY MAKE
TO ENHANCE CARE AS YOU LOOK FORWARD GETTING RID OF AN EMM MODEL AND MOVING TOWARDS A MORE
CAPITATED MODEL FOR THE SERVICES WE PROVIDE.>>SO ONE QUESTION WOULD BE FOR EXAMPLE IN
THE PSYCHOTHERAPY SPACE, OBVIOUSLY SOME MEDICARE PROGRAM DOES PAY FOR PSYCHOTHERAPY, IT PAYS
IF FOR IT CERTAIN AMOUNTS AND SETTINGS, IS THERE A DESIRE TO–RIGHT NOW WE’RE PROPOSING
THAT WE WOULD HAVE AND WE HAVE QUESTIONS ABOUT IT AND I DO WANT TO MIC SURE BEFORE WE RUN
DOWN THIS PATH, I KNOW PAYMENT IS EVERYONE’S FAVORITE TOPIC TO MAKE SURE WE HANDLE THE
PRACTICE FREE DESIGN QUESTIONINGS SO ARE YOU, SOMETHING YOU WOULD ADVOCATE FOR, WOULD BE
THAT IN ADDITION ANY PSYCHOTHERAPY AND ACTIVITIES AND PROJECTS THAT’S WE’RE SEEING OR OTHERS
ARE ALSO LIKE IF YOU ARE GOING TO MAKE IT A CAPITATED MODEL, MAKE IT EVEN BIGGER THAN
WHAT YOU CURRENTLY HAVE, LIKE IN WHAT’S IN HERE IS SORT OF FIRST STEP.
IS IT EASIER MAYBE TO HAVE IT BE BIGGER SO HAVE YOU MORE CONTROL OVER THE WHAT’S HAPPENING
IN IT.>>AS FAR AS BIGGER FOR MORE MONEY THAN FINE.
>>SIZE AND SERVICES.>>NO BUT I THINK–I THINK IF YOU THINK ABOUT
THE WAY WE PRACTICE IN TEXAS FOR EXAMPLE, THE PHYSICIAN IS THE HEAD OF THE TEAM BUT
IN A FEE FOR SERVICE WORLD, THAT MEANS THE PHYSICIAN IS SEEING THE PATIENT MORE REGULARLY
TO MANAGE THAT PATIENT’S CARE, KIENVISION AN INCAPITATED MODEL WHERE THE PHYSICIAN IS
THE HEAD OF THE TEAM BUT THEN OTHER PROVIDERS HELPING PROVIDE CARE SUCH AS ADVANCED CARE
PROVIDER YOU WHICH THEY’RE HELPING BUT THEY ONLY MAKE 80% IF THEY USE THEIR BRAIN WHICH
IS A DIFFERENT SUBJECT BUT I NEVER UNDERSTOOD THAT.
WELL, THEY’RE ONLY ABLE TO BILL 80% IF THEY USE THEIR BRAIN.
SO IN A CAPITATED WORLD I MAY BE ABLE TO FREE UP NURSES TO DO MORE INTENSE NURSING ASSESSMENT
AND BRING UP MY PHYSICIANS RATHER THAN DOING FEE FOR SERVICE WORK, THOSE ARE THE THINGS
KITHINK ABOUT AS WE MOVE INTO MORE OF A CAPITATED SYSTEM.
BUT THEN YOU HAVE TO BE CAREFUL IF WE’RE NOT WILLING ENMS ALL THE TIME ARE YOU DECREASING
PERSPECTIVELY IF WE’RE TRANSEIGHT HOURSING SERVICES TO OTHER PROVIDERS AND FREEING UP
THE PHYSICIANS TO DO MORE WORK RATHER THAN JUST SEEING PATIENTS FOR ENMS,.
>>YES.>>THAT’S MY CONCERN.
>>THERA NO QUESTION THAT HOW THE FEE FOR SERVICE BILLING HAPPENED AND HOW IT MOVES
INTO THE PAYMENT SYSTEM GOING FORWARD BUT WE CAN CERTAINLY TAKE THAT BACK AS SORT OF
A CONCERN THAT WOULD BEAR INTO MAYBE CONTINUING TO BILL AN ENM WITH THE PAYMENT AND HAVING
THE PAYMENT BILL SEPARATELY IS WHAT I’M HEARING TO MAKE SURE ONE DOESN’T DECREASE AGAINST
THE OTHER.>>CORRECT.
>>AARON LIST WITH ONE ONCOLOGY WE’RE A NATIONAL PARTNERSHIP OF OVER 250 ONCOLOGISTS AND OVER
A HUNDRED SITES OF CARE OF CANCER CARE THROUGHOUT THE U.S.
REGARDING THE PRAPBGTIS REDESIGN–PRACTICE REDESIGN ACTIVITIES A PLEA, PLEASE ALLOW PHYSICIANS
AND THEIR CARE TEAMS MAXIMUM FLEXIBILITY IN HOW THEY IMPLEMENT THOSE PRACTICE REDESIGN
ACTIVITIES TO TAILOR THEM TO HELP THE PATIENTS THEY CARE FOR.
THE MORE PRESCRIPTIVE CMMI IS WITH IMPLEMENTATION WITH PRACTICE FREE DESIGN ACTIVITIES, THE
MORE THEY CONSTRAIN THAT INNOVATION THAT I THINK WE CAN ALL AGREE HAS BEEN PRETTY REMARKABLE
IN TERMS OF THE FIRST FEW YEARS OF OCM. SO HERE IS A COUPLE EXAMPLES, WHEN I THINK
BACK TO READING THE RFI FOR OCM, AND THE REQUIREMENT TO USE DATA FOR CONTINUOUS QUALITY IMPROVEMENT,
THAT SOUNDS GOOD TO ME AT THE TIME LIKE A VERY DIFFERENT THING THAN WHAT I LEARNED IT
MEANT TO CMMI, WHAT I LEARNED IT MEANT IS THAT QUALITY PRACTICE VS TO UNDERTAKE SIGNIFICANT
TECHNOLOGY IN HUMAN RESOURCE EXPENSES TO REPORT CLINICAL DATA TO CMMI, THAT’S NOT WHAT I THOUGHT
USING DATA FOR QUALITY IMPROVEMENT WAS GOING TO MEAN WHEN I SAW THE RFI, SO, HOW THAT’S
IMPLEMENTED IN THE FUTURE MODEL IS GOING TO BE VERY IMPORTANT TO YOU KNOW, THE PAYMENT
AMOUNTS THAT DR. CANNED WHAT WAS REFERENCING AND YOU KNOW OUR ABILITY TO IMPLEMENT THE
PRACTICE REDESIGN ACTIVITIES EFFECTIVELY WITH THE–WITH THE MPPTHAT IS GOING TO REPLACE
[INDISCERNIBLE]. SIMILARLY WITH PROS I ACTUALLY HAVE THE LANGUAGE
FROM THE RFI, BUT BASICALLY SAYS, YOU KNOW THERE’S A LINE.
YOU KNOW WE WANT TO SEE EPROS IMPLEMENTED BECAUSE THERE IS EVIDENCE THAT IT HELPS CARE
COORDINATION, PATIENT ENGAGEMENT AND THAT’S TYPICALLY HOW WE HAVE BEEN IMPLEMENTING EPROS,
THAT IS THE MIND SET WE HAVE, THAT’S THE GOAL WE HAVE WHEN WE IMPLEMENT THEM, WE SEE WITH
OUR COMMERCIAL PAYOR, YOU KNOW VALUE BASED PAYMENT MODELS THAT’S REALLY WHAT THEIR GOAL
IS IN TERMS OF REQUIRING THIS TO USE EPROS FOR CARE COORDINATION AND PATIENT ENGAGEMENT.
IT’S A VERY DIFFERENT THING THAN I THOUGHT I HEARD YOU KNOW DISCUSSED EARLIER WHICH IS
FOR THE PURPOSE OF REPORTING, YOU KNOW EPRO DATA TO CMMI, THE MORE PRESCRIPTIVE CMMI IS
IN THE PRECISE DATA POINTS THEY WILL WANT TO SEE REPORTED AND HOW EPROS WILL BE IMPLEMENTED,
THE MORE THEY WILL CONSTRAIN THE INNOVATION THAT IS ALREADY HAPPENING WITH CLINICIANS
IN CARE TEAMS IN THE IMPLEMENTATION OF EPROS. AND I THINK, YOU KNOW I COULD H*F-I THINK
THE OTHER PRACTICE REDESEEN ACTIVITIES, YOU KNOW I THINK I WOULD SRO A SIMILAR CONCERN.
>>CAN I ASK A QUESTION, YOU’RE DOING IT IN THE COMMERCIAL SPACE, THE USE OF THE EPROS
NOW? HAVE YOU COMMERCIAL PAYOR WHO IS ARE REQUIRING
IT? OR NO, YOU JUST STARTED USING THEM FOR YOUR
OWN BENEFIT?>>YEAH, SO THE–TO CLARIFY, THE COMMERCIAL
PAYOR MODELS THAT WERE PARTICIPATING IN AND LOOKING TO PARTICIPATE IN GOING FORWARD REQUIRE
THE PATIENT ENGAGEMENT AND YOU KNOW MANAGING PATIENT OUTSIDE OF THE OFFICE HOURS.
EPROS IS PART OF THAT STRATEGY. SO THAT’S THE–THAT’S NOT–THAT IS SOMETHING
THAT WE CAN DO AND ARE DOING AND LOOK FORWARD TO INVESTING IN FURTHER.
THAT’S SLIGHTLY DIFFERENT THAN WHAT I’M HEARING HAD WHICH IS ADDITIONAL DATA REPORTING REQUIREMENTS
AROUND EPROS, AGAIN IT’S THE SAME, YOU KNOW IT’S IT IS SAME MPP IT’S THE SAME MONTHLY
PAYMENT THAT WE’RE GOING TO BE USING TO FUND THOSE ACTIVITIES.
CMI COULD EASILY CONSTRAIN THAT INNOVATION BY BEING OVERLY PRESCRIPTIVE IN TERMS OF THE
CLINICAL DATA THAT WE HAVE TO REPORT THAT WAS TRUE IN OCM AND IT COULD EASILY APLAY
TO THIS EPRO REQUIREMENT.>>OKAY.
FROM THE PHONE?>>OUR FIRST QUESTION ON THE PHONE COMES FROM
JESSICA WALRAD WITH NORTHWESTERN MEDICAL MEDICINE, YOU MAY GO AHEAD N.
>>HI THIS, IS JESSICA, CAN YOU HEAR ME OKAY? NYES.
>>OKAY, GREAT. WELL FIRST OFF THANKS FOR HOSTING THIS SESSION.
ALWAYS APPRECIATE THAT YOUR TEAM IS WILLING TO TAKE FEEDBACK.
ALSO THANK YOU FOR LISTENING TO SOME OF THE FEEDBACK ON THE TARGET PRICE METHODOLOGY,
I NOTED THE [INDISCERNIBLE] FACTORS NOVEL THERAPY ADJUSTMENT.
I HAD COUPLE QUESTIONS ACTUALLY CLARIFYING QUESTIONS AND I UNDERSTAND THAT THE ANSWER
MIGHT JUST BE TBD OR LET US KNOW WHAT YOU ALL THINK BUT THE FIRST QUESTION IS I SAW
THAT THERE WAS NO MENTION OF SUBMITTING CLINICAL OR STAGING DATA THAT WOULD ULTIMATELY BE USED
FOR TARGET PRICE ADJUSTMENT SO I WANTED TO SEE IF THAT WAS PURPOSEFUL AND IF THERE ARE
NO PLANS TO USE CLINICAL DATA TO ASHES JUST TARGET PRICES?
AND MY SECOND QUESTION WAS WAS A REQUEST THAT YOU SPEAK TO A BIT OF A THOUGHT BEHIND THE
CONSTRUCTION OF THAT PERSPECTIVE RATE AND SPECIFICALLY WHAT LED YOU TO INCLUDE ENM SERVICES
AND THE DRUG ADMINISTRATION FEES AND WHAT YOU HOPE TO ACHIEVE?
SO NO FEEDBACK RIGHT NOW, JUST QUESTIONS.>>FOR THE CLINICAL STAGING DAILY BASIS THEA
WE HAD ENVISIONED CONTINUING TO DO THAT, WE ARE LOOKING TO USE THAT AS YOU KNOW IN OCM
TO DO THE ADJUSTMENTS FOR THE PRICING AND SO, I DON’T ANTICIPATE THAT WE WOULD WANT
TO WALK AWAY FROM THE IMPROVED SPECIFICITY THAT WE CURRENTLY HAVE, SO I–I DON’T KNOW
IF IT WAS NOT MENTIONED–>>YEAH WHAT I WOULD SAY I GUESS JUST IS THAT
I THINK WE’VE BEEN THINKING TWO THINGS, ONE THAT WE WOULD CONTINUE TO COLLECT SOME CLINICAL
DATA AND HOPEFULLY USE IT EVEN MORE THAN WE DO AT THIS POINT IN OCM.
BUT AT THE SAME TIME THAT WE WOULD ALSO REDUCE THE NUMBER OF ELEMENTS THAT WE ARE COLLECTING
TO THOSE THAT WE REALLY BELIEVE WE CAN USE FOR PRICING AND/OR EVALUATION TO MAKE SURE
THAT WE HAVE A STREAMLINED LIST THAT CAUSES MINIMAL BURDEN.
I DID WANT TO NOTE, TOO, THAT IN OCM AND ALSO AS WE’VE THOUGHT ABOUT OCF, USING DAILY BASIS
THEA FOR QUALITY IMPROVEMENT IS ABOUT MORE THAN REPORTING CLINICAL DATA AND QUALITY MEASURE
DATA, THAT’S PART OF IT BUT WE ALSO DO EXPECT AND ASK AND MONITOR THAT PRACTICES IN OCM
RIGHT NOW USE DAT THAT WE PROVIDE AND OTHER DATA THEY HAVE IN HOUSE TO IDENTIFY AREAS
FOR QUALITY IMPROVEMENT.>>FOR WHAT’S GOING INTO THE PROSPECTIVE,
RIGHT? SO WE’RE ACTUALLY HOPING TO HAVE A GOOD CONVERSATION
HERE ABOUT THAT. OUR INITIAL FORAY INTO THE IDEA OF LOOKING
AT SORT OF A PAR PARTIAL CAP WAS TO INCLUDE THE ENMS AND THE DRUG ADMINISTRATION AND THOSE
ARE THE PRIMARY SERVICES OBVIOUSLY THAT ARE BEING FURNISHED IN THE ONCOLOGY OFFICE AND
INTO THE PERSPECTIVE RATE, WE HAVE HAD A LOT OF INTERNAL DISCUSSION AMONGST OURSELVES AND
IT REMAINS AN OPEN ISSUE AS TO WHETHER WE WOULD INCLUDE IMAGING, LABS, ANOTHER ONE THAT
HAS COME UP HAS BEEN THE PLUS SIX ON THE DRUG PAYMENT, WHETHER THAT WOULD BE ROLLED IN INTO
THE PAYMENT WITH THE MIOS, ENMS AND DRUG ADMINISTRATION. I THINK WE HEARD OTHER CONVERSATIONS TODAY
ABOUT WHETHER THERE ARE OTHER SERVICE SERVICES THAT MAY OR MAY NOT BE APPROPRIATE FOR INCLUDING.
WE IDENTIFIED THOSE SERVICES BECAUSE WHEN WE LOOK AT THE PATTERN OF BILLING THAT’S HAPPENING
RIGHT NOW, THAT’S WHAT WE SEE HAPPENING NEXT ONCE YOU GET PAST THE DRUG ADMIN WE SEE LABS
AND IMAGING, THIS SHOULD NOT COME AS A SURPRISE, SO WE’VE ACTUALLY BEEN ASKING YOURSELF HOW
BROAD THE SCOPE OF THAT PERSPECTIVE PAYMENT, THAT CAPITATED PAYMENT SHOULD BE, AND WE ARE
VERY INTERESTED IN HEARING WHAT FOLKS WOULD PREFER TO SEE IN THAT SPACE.
NEARS GOT IT, THANK YOU.>>AND IF YOU HAVE AN ANSWER, WE WOULD TAKE
IT.>>I AM INTERESTED IN HEARING OTHER THOUGHTS
NORTHWESTERN SUBMITTED THE COMMENT LATER ON THE RADIATION ONCOLOGY MODEL SO WE HAVE THOUGHTSA
THE PERSPECTIVE PAYMENT, WITH CANCER CARE AND WE THINK IN GENERAL VERY SUPPORTIVE–BUT
SEEING HO YOU DIFFICULT IT IS TO ACCURATELY RISK ADJUST THE FINANCIAL BENCHMARK FOR THAT
POPULATION, EVEN ROUGH ATOM RETINAL LOCATION SPECTIVELY, THIS CAUTION AGAIN GROUPING TOO
MUCH INTO ANY KIND OF PERSPECTIVE RATE BECAUSE CASE MIX CHANGES SO MUCH FROM EFTHIMIOS CORICAL–HISTORICAL
BUT I WANT TO PROCEED INTO CAUTION BUT PUTTING A PERSPECTIVE RATE INTO CANCER CARE.
>>THANK YOU. WE HAVE ONE MORE ON THE PHONE.
>>YES, THE NEXT QUESTION COMES FROM ROM WITH SIERRA HEMATOLOGY AND ONCOLOGY.
YOU MAY GO AHEAD.>>OH I’M SORRY, DR. [INDISCERNIBLE] JUST
STEPPED OUT FOR A WHILE, CAN YOU SKIP US FOR NOW.
>>THANK YOU.>>THE NEXT QUESTION–
>>THAT WORKED OUT GREAT.>>COMES FROM CO LET PITMAN WITH MIN MACHINE
COMMUNITY MEASUREMENT, YOU MAY GO AHEAD.>>GREAT.
THANK YOU. I AM CO LET PITMAN, I AM A DEVELOPER WITH
MIN MEN COMMUNITY MIXTUREMENT AND I REALLY APPRECIATE THE COMMENTS ABOUT SERVING PATIENTS
WITH A LOT OF QUESTIONS AND I JUST WANTED TO SHARE OUR EXPERIENCE.
OUR MEASURE DEVELOPMENT WORK GROUP HAS ACTUALLY DEVELOPED FOR USING THE GROUP, PRO CTAEC TOOL
BUT WE’RE FOCUSING ON THAT THE WORK GROUP FELT WAS THE MOST ACTIONABLE AND DEVELOPED
AN OUTCOME DURING CHEMO THERAPY FOR PAIN, NAUSEA AND CONSTIPATION BUT WHAT’S NICE ABOUT
THE MCI TOOL IS THAT YOU CAN SELECT THE MEASUREMENTS FOR OUTCOMES BUT YOU CAN SELECT OTHER INTERESTS
SO THAT INTERESTED IN FOR TOOLS THAT YOU WOULD ADDITIONALLY LIKE TO ASK THE PATIENT INSTEAD
OF PERHAPS ASKING 86 QUESTIONS. SO THANK YOU SO WE WILL GO BACK TO THE ROOM
FOR THE COMMENTS.>>SO YOU ASKED A QUESTION ABOUT IMAGING AND
LABS AND INCLUDED IN PERSPECTIVES SO WE HAVE FORM GROUPS AND LOOK AT DATA THAT THEY ONLY
ANSWER THAT THING FOR THE PEARS CENTERED ONCOLOGIA PAYMENT MODEL, I CAN TELL YOU A LOT OF IT
AT THE INITIATION OF CARE CAME DOWN TO TIMING.>>YOU KNOW SO WE GOT INTO THE ALL OF THESE
LOOK BACKS AND YOU KNOW DID A LAP HAPPEN PRIOR TO THE IPT GREATERRISHIATION AND EPISODE IT
IS AFTERWARDS AND IT GOT KIND OF MISSY THERE AND SO I WOULD KIND OF REPEAT THAT OR URGE
CAUTION TO INCLUDE IMAGING AND LABS, YOU KNOW @ THE ONSET AND CONFIGURE SOME OF THAT OUT
BUT WHY I CAME UP HERE IS RELATED TO THE QUESTION OF CARE REDESEEN ACTIVITIES AND WHAT COULD
WE LEARN FROM OCM. ONE OF THESE IS ASCO PUBLISHER OF GUIDELINES
WE ENJOY THAT REDESIGN ACTIVITY ABOUT YOU WE WERE HOPING TO SEE IT EVOLVE INTO SPECIFICALLY
ON DRUGS USE OF CLINICAL TREATMENT PATHWAYSA THE PRACTICE LEVEL AND YOU KNOW OTHER OTHER
MODELS HAVE SHOWN THAT THAT REALLY HAS A DUAL BENEFIT.
ONE IS WE CAN ENHANCE THE QUALITY OF CARE FOR PARENT PATIENTS TO INSURE THAT THEY ARE
GOING TO RECEIVE THE MOST APPROPRIATE DRUG BASED UPON EFFICACY.
BUT THEN ALSO ON THE ISSUE OF COST, THEY’VE SHOWN NOT ONLY A REDUCTION IN COST, BUT ALSO
A METHOD TO KEEP PROVIDERS ACCOUNTABLE FOR UTILIZATION OF DRUGS.
WHILE NOT HAVING TO INCLUDE THOSE DRUGS ON THE TOTAL COST OF CARE AND MAKING PROVIDERS
RESPONSIBILITY FOR THE LIST PRICE SO WE WOULD LIKE TO SEE FURTHER THOUGHT ON THAT CARE REDESIGN
ACTIVITY AND HOW MAYBE, YOU KNOW AN EVOLUTION OF THAT COULD IMPROVE BOTH THE QUALITY MEASUREMENT
AS WELL AS ADDRESSING THE COSTS IN A WAY THAT I THINK WOULD BE MORE PALIABLE TO PROVIDERS
IN THE MODEL.>>CAN I ASK A QUICK QUESTION?
WE HAD A LOT OF CONVERSATIONS WHEN WE WERE DESIGNING OCM AROUND PATHWAYS VERSUS GUIDELINES
AND WE RIGHT NONAPOPTOTIC YOU IN OCM, IF WE WERE BUILT AROUND THEY CAN BE USE INDEED MANY
PRACTICES TO USE PATHWAYS BUT WE HAD A NUMBER OF CONVERSATIONS AROUND THE CHALLENGE OF PATHWAYS,
OFTEN TIMES BEING PROPRIETARY AND WONDER IF YOU HAVE ANY THOUGHTS ON HOW WE CAN NAVIGATE
THAT? SO I THINK WE’VE GONE A LONG WAYS SINCE THE
INITIATION OF OCM, SO IT’S TAKEN THAT FEEDBACK AND THAT CHALLENGE ON, OF LOOKING WHAT ARE
THE CRITERIA, THAT WE EXPECT FROM PATHWAYS, YOU KNOW AND WADO WE EXPECT THEM TO DO, EVALUATING
CURRENT PATHWAYS OUT THERE, YOU KNOW AND WE CERTAINLY CAN CONTINUE TO BE A PARTNER IN
THAT BUT REALLY TO HAVE A SET OF CRITERIA, AND THEN, YOU KNOW FEEL FREE TO FORWARD IT
ON TO YOU, YOU KNOW THE POINTS THAT WE EXPECT TO SEE IN THOSE PACT WAYS IS IMPORTANT.
RIGHT? BECAUSE IT CAN’T BE, WELL JUST A PATHWAY IS
A PATHWAY, YOU WANT TO EXPECT CERTAIN TRANSPARENCY AND DECISION MAKING AND SO ON.
SO I THINK WE’RE A LOT FURTHER ALONG ON THAT PATH.
AND READY FOR THE ONCOLOGY CARE FIRST MODEL.>>THANKS.
>>GO AHEAD NICK.>>NICK [INDISCERNIBLE] WITH PENN MEDICINE
IN PENNSYLVANIA. I WANT TO START OFF BY SAYING LEADING CANCER
PRACTICES AND HOSPITAL BASED PROGRAMS FOR 16 YEARS AND THE ONCOLOGY CARE MODEL IS BEEN
A FIRST TIME THEY FEEL LIKE I’VE BEEN ABLE TO MAKE A DIFFERENCE IN IMPROVING THE QUALITY
OF CARE. I THINK IT’S BECAUSE THE ONCOLOGY CARE MODEL
FOR US HAS BEEN NOT JUST OUR TOP QUALITY IMPROVEMENT ACTIVITY, IT’S PROBABLY BEEN OUR TOP 20 ALTOGETHER,
IT’S LED TO A LOT OF GREAT THINGS, AND AS FAR AS THE AND AS FAR AS ACTIVITIES GO, I
DON’T MIND THOSE ARE DIFFICULT, IF CARE TRANSFORMATION WAS EASY TO DO, WE WOULDN’T NEED THIS MODEL
SO THAT DOESN’T REALLY BOTHER ME, I THINK THE COMMENT THAT I DO WANT TO MAKE IS ABOUT
THE CARE TRANSFORMATION ACTIVITIES BEING DIFFICULT TO IMPLEMENT AS A REQUIREMENT FOR ELIGIBILITY
AND IN PARTICULAR, TOO, COME TOGETHER AROUND USING A CERTIFIED EMR, AND THEN REPORTING
ON QUALITY DATA AND I JUST LIKE TO SEE SOME COORDINATION BETWEEN CMMI AND THE OFFICE OF
THE NATIONAL COORDINATOR PERPERHAPS TO BE ELIGIBLE AT THE HR, YOU SHOULD HAVE TO DEMON
TRAIT THAT YOUR PLATFORM CAN REPORT THOSE QUALITY MEASURES, FOR US THAT IS POSSIBLE
BUT IT TAKES SO MUCH MACHINUAL EFFORT TO DO THE ELECTRONIC RECORDINGS THAT WE JUST DO
MANUEL COLLECTION AND MANUEL REPORTING OF ALL THE QUALITY MEASURES AND THAT–THAT A
BIT UNREASONABLE AND I THINK MAY LIMIT OTHER PRACTICES THAT AREN’T CURRENTLY PARTICIPATING
FROM JOINING UP OR THEY MIGHT FIND THEY REGRET PARTICIPATING SOPHISTICATED I THINK WE’RE
LOOKING FOR HELP FROM CMMI, TO HELP PROD THE VENDORS TO MOVE FORWARD BECAUSE OUR PLEAS
ARE SOMETIMES FALLING ON DEAF EARS.>>AND NICK IS THAT FOR QUALITY MEASURES AND
CLINICAL DATA OR JUST EVERYTHING.>>EVERYTHING.
>>[INDISCERNIBLE]–ANYTHING FROM THE EMR IN A REASONABLE FASHION, YES?
>>RIGHT.>>GOOD MORNING.
>>GOOD AFTERNOON.>>WHAT IS WITH ME?
[LAUGHTER]>>HI, EVERYONE I’M [INDISCERNIBLE] SENIOR
VICE PRESIDENT U.S. AND GLOBAL DEVELOPMENT OF NCCN, MANY OF YOU KNOW ALREADY KNOW WHO
NCCN IS, BUT FOR THOSE WHO DON’T ISSUES WE’RE AN ALLIANCE OF 28 LEADING ACADEMIC CANCER
CENTERS, WE ARE DEVOTED TO IMPROVING AND FACILITATING QUALITY, EFFECTIVE AND EFFICIENT AND ACCESSIBLE
CANCER CARE SO PATIENT CANS LIVE BETTER LIVES. JUST RELATED TO YOUR QUESTION EARLIER, ABOUT
PATHWAYS AND GUIDELINES, I THINK INFORMATION ABOUT THE GUIDELINES HELPS TO ANSWER THAT
QUESTION, THE NCCN GUIDELINES ARE COMPREHENSIVE, THEY SUPPORT DECISION MAKING, ACROSS THE CONTINUUM
OF CARE, THEY’RE TRANSPARENT. THEY’RE CONTINUOUSLY UPDATED, AND THEY ARE
THE BASIS FOR ALMOST ALL PATHWAYS THAT I AM AWARE OF AT THIS POINT.
SO WE APPLAUD YOU FOR KEEP THAGOREAN IN THE OCF MODEL.
IN FACT WE,A PHRAUD YOU, WE ARE HERE TO SUPPORT YOU.
WE’RE REALLY HAPPY WITH WHAT QUEUE DONE AND WE HOPE YOU WILL CONTINUE TO ADVANCE VALUE
BASED MODELS. AS I MENTION WE ARE GRATEFUL THAT YOU’RE CONTINUING
TO KEEP GUIDELINES LIKE NCCN GUIDELINES AS AN EVIDENCE-BASED DRIVEN BASE LINE FOR QUALITY.
WE APPLAUD YOU FOR FOCUSING ON VALUE, TOO. THERE’S TWO RECENT STUDIES THAT DEMONSTRATE
THE ECONOMIC VALUE OF GUIDELINE AND CONCORDANT CARE, I KNOW YOU’RE FAMILIAR WITH THE FIRST
ONE. THE 2016 STUDY CONDUCTED BY UNITED CANNED
WHAT AND NCCN, THAT DEMONSTRATED MANDATORY ADHERENCE TO NCCN GUIDELINES SIGNIFICANTLY
REDUCE TOTEDDAL AND EPISODIC COST OF CARE, DRUG COSTS REDUCED BY 20% IN FLORIDA AS COMPARED
TO NATIONWIDE DATA. BUT A RECENT STUDY PUBLISHED JUST LAST MONTH.
ENTITLED GUIDELINES DISCORDANT AND PATIENT COST RESPONSIBILITY AND MEDICARE BENEFICIARIES
WITH MEDIA STATIC PREFT CANCER FOUND THAT THE MEDIAN COST FOR METASTATIC BREAST CANCER
PATIENTS RECEIVING GUIDELINES DISCORDANT TREATMENT WAS HIGHER THAN THOSE RECEIVING GUIDELINE
CONCOTTER ANDROGEN CARE. AND ADJUSTED MODELS GUIDELINE DISCORDANT CARE
TREATMENT WAS SIGNIFICANTLY ASSOCIATED WITH NEARLY $2000 HIGHER PATIENT OUTOF POCKET COSTS.
THE STUDY SHOWS THAT JUST UTILIZING NCCN GUIDELINES DOES SAVE MONEY WITHOUT HAVING TO NARROW CHOICES.
THE EVIDENCE-BASED CHOICES INCLUDED. WE CONGOTTULATE YOU AND RECOGNIZE THAT OCM
AS RESULTED IN CARE TRANSFORMATION. AND IN THE IMPROVEMENT OF NUMBER OF IMPORTANT
SERVICES ENCLUEDING CARE COORDINATION, PATIENT NAVIGATORS NUTRITION SERVICES AND DATA ANALYTICS
WHICH YOU’VE SPOKEN ABOUT. WE SUPPORT CMMI’S PROPOSAL TO CONTINUE THIS
PRACTICE REDESEEN ACTIVITIES AND THE ON, CF MODEL, THAT SAID WE DO BELIEVE THAT THERE
ARE STILL AREAS IF IMPEDIMENTS PROVEMENT TO MEET THE NEEDS OF DIVERSE ONCOLOGY PRACTICES.
ACADEMIC CANCER CENTERS OFFER MULTIDISCIPLINARY CARE, TREAT COMPLEX PATIENTSES AND FREQUENTLY
SHARE CARE RESPONSIBILITY WITH OTHER PROVIDERS, IT SOUNDS LIKE YOU’RE TRYING TO DEAL WITH
THAT IN THE ABUTION BUT WE HAVEN’T HAD TIME TO SPEAK TO MEMBER INSTITUTIONS SO WE SUPPORT
TED’S ASK FOR MORE THAN 15 AT AS TO SUBMIT MORE COMMENT ON THAT.
BUT WE DO ENCOURAGE THAT TO BE ADDRESSED IN THE OCF MODEL MORE OVER WE BELIEVE THAT THE
FUTURE OF VALUE BASED PAYMENT WITH AN ONCOLOGY IN ORDER TO BE SUCCESSFUL HAS TO CONSIDER
THESE DIVERSE ONCOLOGY PRACTICES AND WE CONTINUE TO SUPPORT NOT JUST ONE MODEL SO A FUNDING
MECHANISM TO MOVE OTHER MODELS FOR THE AND THE MASON MODEL, FASON PROPOSES TO INCLUDE
A TECHNICAL QUALITY METRIC REQUIRING AT LEAST 80% COMPLIANCE TO PATHWAYS EMPLOYING THE NCC
AND GUIDE LINES TO INSURE QUALITY OF CARE, WE ARE COMMITTED TO SUPPORTING THAT PROGRAM.
SO AS YOU ADVANCE VALUE PACED MODELS WE APPLAUD YOU.
THANK YOU SO MUCH FOR ALL YOUR DOING, AND FOR YOUR CONTINUED USE OF GUIDELINE ADHERENCE
AS THE GUARD RAIL FOR QUALITY, AND WE ASK YOU TO CONSIDER THE NEEDS OF DIVERSE MODEL
PRACTICE PARTICIPANTS AND THANK YOU AGAIN.>>YOU’RE GOOD?
THANK YOU VERY MUCH. I’M DAVE I PITMAN WITH THE NATIONAL CHANNEL
OF ORGANIZATIONS, MY ISSUE IS WHEN I GO OUT OF TURN BUT MY ISSUE WASN’T NECESSARILY ADDRESSED
IN THE FOUR QUESTIONS IN THE RFI BUT IT DEALS WITH OVERLAP.
YOU DO ADDRESS IT AT THE VERY END IN ONE SENTENCE SAYING SOMETHING LIKE YOU’LL DEAL WITH IT
MORE BUT I’M HOPING MAYBE YOU CAN SHED SOME LIGHT ON WHAT YOU’RE THINKING?
BECAUSE JUST FROM–FROM OUR CONSTITUENTS, ACOS ABOUT 11 MILLION PATIENTS IN THE SAVINGS
PROGRAM ALONE, AT NEXT GENERATED, ACOS TO THAT, IT’S ABOUT 20% OF ALL MEDICARE AND ROUGHLY
A THIRD OF FEE FOR SERVICE MEDICARE SO IF WE’RE GETTING TO RIGHT A PLACE LIKE THE ADMINISTRATOR
REFERENCE IN HER REMARKS WHERE GROWING MODELS AND GROWING PARTICIPATION, PARTICIPATION EVENTUALLY,
ALL THESE MODELS WILL OVERLAP AND CONFLICT WITH EACH OTHER AND PATIENTS WILL HAVE A CURRENT
CARE DOC AND ACO AND SPECIALIST IN A–SOME SPECIALTY DRIVEN MODEL, SO TRYING TO SOLVE
SOME OF THESE ISSUE SYSTEM NECESSARY AND YOU’RE ALL SHAKING YOUR HEAD AND I KNOW THIS ISN’T
AN ISSUE NEW TO CMMI, BUT I GUESS I’M HOPING IF YOU CAN ONE, SHED LIGHT ON WHAT YOU’RE
DOING OR THINK BEING THIS ISSUE AND TO WHAT CAN WE DO TO HELP YOU SOLVE THIS ISSUE?
BECAUSE IT’S NOT BEEN–IT’S NOT NEW TO YOU GUYS BUT I THINK JUST OUR POSITION JUST TO
MAKE IT YOUR FEEDBACK NOW, WE BELIEVE THAT TOTAL COST OF CARE MODELS LIKE ICOS SHOULD
BE GIB PRY ARITY AND WE FEEL THAT WHEN YOU PROVIDE–GIVE PROVIDERS, MAKE PROVIDERS ACCOUNTABLE
FOR ALL OF MEDICARE, AND SPEBDING CAN YOU ADDRESS ALL THE PATIENT NEEDS, SOCIAL DETERMINANTS
THAT ARE ADDRESSED AND YOU CAN REALLY EFFECTIVELY CONTROL OR CONTROL COSTS AND IMPROVE QUALITY
BUT AGAIN JUST WHAT CAN WE DO TO HELP YOU TRY TO ADDRESS THIS ISSUE; SO I’LL SPEAK TO
OVERLAP FOR JUST ONE MINUTE AND THAT GOES FOR ALL MODELS.
IN THIS CASE, YOU HAVE AN EPISODIC MODEL OF SOME KIND MOVING INTO THIS THAT WE’RE LOOKING
AT HERE, EVEN THOUGH THE PVPM IS GOING TO BE BASED IN THIS PAPER AFTER THIS CONVERSATION.
WE HAVE A LOT OF HAPPENING TO DO, ON AN EPISODIC BASIS THERE. ‘S OBVIOUSLY MANAGEMENT THAT’S
GOING TO BE HAPPENING YEAR ROUND, RIGHT? AND HOW YOU EMBED THAT WITHIN THE ACO SPACE,
OR ANY OTHER MODELS THAT’S UNDERWAY REMAINS AN ISSUE.
RIGHT NOW AS YOU KNOW WE DO IT BY SOME–WE HANDLE IT IN A LOT OF DIFFERENT WAYS, WE EITHER
GIVE PRECEDENCE TO CERTAIN MODELS, WE DO SORT OF AN ACCOUNTING ON THE BACK END.
I KNOW YOU IF ARE PARTICIPATE NOTHING OCM, YOU HAVE TO PULL OUT A CERTAIN AMOUNT PARTICIPATE
NOTHING ACO, OUR GOAL WOULD BE TO FIGURE OUT TO YOU HO ACCOUNT FOR THE OVERLAPS AND BY
OVERLAPS WHAT WE’RE USUALLY DEALING WITH IS AN ASSESSMENT OF DOUBLE PAIRED SAVINGS AND
THAT IS WHAT IT IS FOR PURPOSES OF BEING BUDGET NEUTRAL ACROSS THE SYSTEM ESSENTIALLY, SO
IN AN–IN A WORLD THAT DOESN’T EXIST RIGHT NOW, WE WOULD HAVE A WAY TO DO THAT, THAT
WOULD BE LESS ONEROUS, EITHER THROUGH PRECEDENCE OR THE ACCOUNTING COMPONENT.
BUT WITH WE ARE IS SORT OF EXPLORING HOW TO DO THAT.
THE RECENTLY NOT IN THE ONCOLOGY SPACE FOR BROADER BUNDLES [INDISCERNIBLE] FOR EXAMPLE,
WE DID NOT END UP HAVING TO PROCLUED MSSRP PARTICIPANTS FROM THE BBCI PARTICIPATION AND
THAT HAD TO DO WITH AN ACTUARIAL ACCOUNTING FOR HOW THE TREND FACTORS COME TOGETHER FOR
THOSE TWO MODEL OPEN SOURCE SOFTWARE SO OOH DEALLY THAT WOULD BE A PATHWAY FORWARD FOR
US TO LOOK FORWARD THROUGH AS WE BRING UP NEW MODELS.
I DON’T HAVE AN ANSWER FOR YOU RIGHT AT THIS MOMENT BECAUSE IT IS DEPENDENT TO SOME DEGREE
ON HOW THEY’RE CALCULATED BUT I THINK IDEALLY WE WOULD BE IN A PLACE WHERE THOSE CONSIDERATIONS
ARE SORT OF PREACCOUNTED FOR BEFORE IT COMES TO THE PARTICIPANTS SO THAT WHEN I’M THE ONCOLOGY
PROJECTIS PARTICIPATING, OR I’M THE ACO, IT’S SORT OF NOT RELEVANT TO ME, RIGHT?
I CAN BE COORDINATING WITH THE ACO, I CAN HAVE THE SAME BENEFICIARIES AND I DON’T REALLY
HAVE TO GET INTO FIGURING OUT WHO IS GIVING WHO MONEY BACK.
THAT IS THE GOAL, WE HAVE A WAYS TO GET THERE BUT THAT IS THE VISION ULTIMATELY.
>>HI, GOOD AFTERNOON I’M [INDISCERNIBLE] FROM AFTERWAY HEALTH WHICH IS LOCATED IN BOSTON,
MASSACHUSETTS, WE ARE HERE WITH MY COLLEAGUES. WE APPRECIATE THIS OPPORTUNITY TO PARTICIPATE
IN THE PUBLIC LISTENING SESSION AND ECHO OTHERS AND COMMENDING YOU FOR YOUR COMMITMENT TO
EVOLVING VALUE BASED CARE MODELS AS WELL AS YOUR TRANSPARENCY IN SOME OF THEICAL EFRBLGERGS
AND DEVELOPING ONCOLOGY EPISODIC PACE MODELS, WITH REGARDS TO THE FEEDBACK ON ENABLING CARE
TRANSFORMATION, YOU KNOW IT’S–THERE’S A STRONG NEED FOR OCM PRACTICES TODAY TO HAVE MORE
DETAILED BENEFICIARY CLAIMS DATA FOR THEIR PATIENTS.
YOU KNOW HAVING THIS FULL OF A MEDICAL HISTORY AS POSSIBLE IS REALLY IMPORTANT TO IMPLEMENTING
BOTH PATIENT SPECIFIC AND POPULATION BASED CARE IMPROVEMENT ACTIVITIES AND WHILE IT IS
TRUE THAT PROVIDERS CAN GATHER FENNISTERATION BENEFICIARYIARY MEDICAL HISTORY DIRECTLY FROM
BEN WISHIARYS IT’S NOT REALISTIC TO LET IT EXPECT, ESPECIALLY THOSE HO HAVE AGED INTO
MEDICARE TO REMEMBER ALL OF THEIR PAST MEDICAL HISTORY OR EVEN BE ABLE TO IDENTIFY UPON A
QUESTION WHAT THE CO-MORBIDITIES ARE IN BBCI ADVANCED WE RECEIVE MONTHLY, VERY RICH DATA
THAT INCLUDES ALL RISK PARAMETERS THAT INCLUDES PATIENT CO-MORBIDITIES, DOCUMENT INDEED THE
90 DAYS LETTING UP TO THE EPISODE AND THIS INFORMATION HAS BEEN HUGELY VALUABLE FOR PROVIDERS
AND BBCI ADVANCED IMPLEMENTING CARE IMPROVEMENT ACTIVITIES IN COURSE CORRECTING SOME OF THE
NEW INITIATIVES THAT THEY’RE NEWLY INITIATING AND WANT REALTIME FEEDBACK ON SO THIS HAS
BEEN REALLY HELPFUL AND THEN ALONG THOSE LINES WE WOULD ENCOURAGE CMS TO START PROVIDING
SUBSETS OF RECORDS FROM THE MODEL OUT PATIENT FILES RELEVANT TO OCM BENEFICIARIES AND THE
ONGOING DATA THAT’S PROVIDED TO OCM PARTICIPANTS.>>WHAT DO YOU MEAN BY THAT?
>>SO IN VERSION 22, THESE MODEL OUTPUT FILES THERE ARE CERTAIN SUBETS OF THAT THAT WE’VE
REQUESTED THAT WOULD BE REEL KEEPSAKES SRABT TO AN OCM BENEFICIARY SUCH AS KIND OF CO-MORBIDITIES
OR HCCS THAT WOULD HELP PROVIDERS IN BBCI ADVANCED AND BETTER TAILORING THEIR INTERVENTIONS
TO SPECIFIC PATIENT NEEDS. ANOTHER AVENUE FOR PROVIDING PATIENT HISTORICAL
DATA WOULD BE USING THE BLUE BUTTON 2.0 PLATFORM. HOWEVER IT IS BEEN IN OUR EXPERIENCE THAT
CAN BE CHALLENGING TO HAVE MEDICARE BENEFICIARIES ENROLL IN OTHERS DON’T HAVE ACCESS OR EXPERIENCE
TO BE ABLE TO DO THIS. WE DO THINK THAT THE DATA AT THE POINT OF
CARE OR BPC OR API ARE MORE PRACTICAL APPROACHES TO GIVING PROVIDERS ACCESS TO THIS DATA THOUGH
WE WOULD ENCOURAGE KMMI TO ADVIDEOICATE FOR EXPANSION OF THESE PLATFORMS, FOR OCM AND
CONICOLOGY CARE FITTER PARTICIPANTS WITHOUT THE CURRENT RESTRICTIONS SUCH AS DATA THE
AT POINT OF CARE AND JUST TO PROVIEDMAN A QUICK EXAMPLE OF WHY HAVING PATIENTS SPECIFIC
DETAILED TPH-FGZ BOTH HISTORICALLY AND ONAN ONGOING BASIS WOULD ENABLE PRACTICE TO IMPROVE
THIS, OUR GROUP WORKS WITH 20 GROUPS IN OCM AND A LOT OF SPECIALISTS IN BBCI ADVANCED
IS PATIENTS WITH UNDERLYING HEART CONDITIONS NOT RECEIVING WELL MANAGED CARDIOVASCULAR
CARE ONCE THEY’RE UNDERGOING CHEAP ORE O THERAPY, IT’S NOT UNCOMMON UNFORTUNATELY THAT WHEN
A PATIENT IS DIAGNOSED WITH CANCER HISSER HER TREATMENT FOR OTHER CONDITIONS WILL FALL
OFF TRACK AS THE CANCER TREATMENT BECOMES THE PRIMARY FOCUS WE’VE SEEN IN OUR ANALYSIS
OF THE 20 OCM PRACTICES THAT WE HAVE DATA FOR SOME OF THE TOP DRIVERS OF SPENDING IN
READMISSION IN THE ER VISITS BEING CARDIOVASCULAR RELATED AND OCM PRACTICES HAD BETTER DATA
ON CO-MORBIDITIES AND, ACIN AND OTHER HEART DISEASE THAT WOULD HELP BE ABLE TO CRAFT MORE
PATIENTS SPECIFIC AND POPULATION BASED INTERVENTIONS. WE HAVE FEEDBACK ANDY WOO WILL WAIT TILL YOU
GO THOSE QUESTIONS TO PROVIDE THOSE. THANK YOU VERY MUCH FOR YOUR TIME.
>>THANK YOU. WHO ELSE HAS PRACTICE RE DESIGNED COMMENTS?
YES IN IF YOU HAVE A PRACTICE AREY DESIGN COMMENT BECAUSE I’M KEEPING AN EYE ON THE
TIME AND WE HAVEN’T EVEN MADE IT TO RISK ARRANGEMENTS YET AND I KNOW EVERYONE DOESN’T WANT TO TALK
ABOUT THAT ONE. SOUTH AMERICA SURE, THANK YOU ASHLEY [INDISCERNIBLE]
WITH NEW CENTURY HEALTH AND JUST THANK YOU YOU FOR THE OPPORTUNITY TO COMMENT.
THE FACT THAT DOING THIS IS SHOWS YOU’RE LISTENING AS WE’VE ALL ASKED FOR OPPORTUNITIES LIKE
THIS, I WOULD AGREE WE WOULD LIKE MORE TIME TO COMMENT IN WRITING ABOUT I WOULD SAY, JUST
A COUPLE THINGS ON THE PRACTICE REDESIGN SIDE, SOMEBODY TALKED ABOUT THE BURDEN OF DATA COLLECTION
THAT’S REQUIRE INDEED IN MODEL, I THINK WE CERTAINLY SEEN THAT, TOO, TO MAYBE ONE WAY
TO REDUCE THAT IS TO FOCUS ON MEASURES AND I KNOW WE’VE WEIGHED IN ON THIS BEFORE THAT
ARE PRIMARILY CLAIMS BASED MEASURES THAT DON’T REALLY REQUIRE A LOT OF EXTRA DATA COLLECTION.
SO BEFORE MEASURES THAT WE WOULD SUGGEST ARE E. R. VISIT RATE, ADMISSION RATE FOR MEDICAL
DIAGNOSIS, HOSPITAL USE RATE, AND ALSO ADHERENCE TO CLINICAL PATHWAYS.
I KNOW THIS IS COME UP BEFORE, I GUESS I WOULD SAY, YOU KNOW THERE ARE PUBLIC PATHWAYS, NEW
CENTURY HEALTH PATHWAYS ARE PUBLIC, AND CAN BE ACCESSED ON ONLINE, YOU KNOW, ONE WAY ON
DO IT WOULD BE TO REQUIRE THE USE OF PATHWAYS, WITHIN THE MODEL, AND THEN TO MAKE ADHERENCE
TO THE PATHWAYS OF QUALITY MEASURE, THOSE PATHWAYS COULD BE SORT OF DEEMED OR APPROVED
BY AN OUTSIDE ENTITY LIKE ASCO OR NCCN, SO THAT’S ONE WAY TO KIND OF DO IT WITHOUT, YOU
KNOW CMS WOULDN’T CERTAINLY HAVE TO CREATE THE PATHWAYS BUT REALLY GOOD PATH IS ALREADY
EXIST AND WE HEARD FROM ASCO AND NCCN ON THAT SO THAT’S THE ONLY OTHER THINK THIS I WOULD
ADD TO THAT AND I KNOW WE WILL HAVE A LOT OF COMMENTS ON THE PAYMENT MODEL AS WELL.
SO THANK YOU. ON THE PHONE FOR PRACTICE REDESIGN QUESTIONS.
>>OUR NEXT QUESTION ON THE PHONE AND RON [INDISCERNIBLE] WITH HEMATOLOGY AND ONCOLOGY.
>>HE’S STILL WITH A PATIENT RIGHT NOW, YOU CAN SKIP US.
>>OKAY, THANK YOU. OUR NEXT QUESTION IS FROM CHERYL PRINCE WITH
WEST CLINIC MEMPHIS TENNESSEE, YOU MAY GO AHEAD.
>>YES, THANK YOU FOR THE MEETING TODAY, I APPRECIATE BEING HERE ONE OF THE THINGS I
WOULD LOAMACYIC TO COMMENT ON IS YOUR DESIRE TO PROVIDE US WITH MORE REALTIME DATA THAT
IS EXTREMELY VALUABLE. AND I THINK THE LAST PERSON FROM AFTERWAY
PUT DIRECTLY IN FOCUS WHAT WE’VE REALLY ARE LOOKING FOR AND WHY WE’RE LOOKING FOR IT.
THE SECOND COMMENT HAS TO DO WITH SUPPORTING PREVIOUS COMMENTS REGARDING QUALITY CARE MEASURES,
I PERSONALLY, I FEEL LIKE THEY’RE MORE DIRECTED TOWARDS COST AND VALUE, WITH EMERGENCY DEPARTMENT
END OF LIFE, HOSPICE ALL BEING REALLY SURROGATES FOR QUALITY AND I WOULD LIKE TO ENCOURAGE
MORE DIRECT MEASURES OF LOOKING FOR EXAMPLE AT GUIDELINE ADHERENCE THAT WE’RE ACTUALLY
ORDERING THE CORRECT TREATMENT AT THE CORRECT TIME.
THIS IS PARTICULARLY PERTINENT WITH REGARD TO THE ADVENT OF THE IMMUNOTHERAPY AND PRECISION
MEDICINE. THE THIRD COMMENT TAGS ON TO THE EPRO.
I’D LIKE TO SUPPORT AARONEE COMMENTS TO MOZ NOT SACRIFICE INNOVATION FOR MORE CLINICAL
DATA. I DO THINK THAT’S A REAL ISSUE FOR US WITH
CURRENT REPORTING OF CLINICAL DATA. AND IN–AND IN LISTENING TO YOUR COMMENTS
EARLIER, REGARDING EPROS, MY QUESTION IS, IT SOUNDS LIKE Y’ALL MAY BE CONSIDERING SPECIFYING
CERTAIN EPROS DOWN THE LINE THAT WE MUST USE, DID I MISINTERPRET THAT COMMENT?
>>I THINK WE DON’T KNOW YET. WE ARE THINKING ABOUT WAWE MIGHT DO IN THIS
SPACE. YOU COULD SEE A LOT OF PATHS FORWARD WHERE
IT WOULD BE HELPFUL TO AT LEAST HAVE A SMALL SUBSET OF CHOICES SO THAT THERE WOULD BE A
WAY TO LOOK AT THE DAILY BASIS THEA WITHOUT NECESSARILY TYING EVERYONE’S HANDS.
I THINK, YOU KNOW YOU’RE US, YOU WANT KNOW WO, IF YOU’RE EVERYONE ELSE, YOU PREFER TO
USE YOUR OWN, YOU’RE OPEN TO HEARING WHAT PEOPLE THINK WOULD BE THE MOST FRUITFUL PATH
FORWARD IN A WAY THAT COULD BE USEFUL TO THE MODEL AND USEFUL TO THE PRACTICES.
>>I WOULD JUST ENCOURAGE YOU IN THIS REGARD TO RECOGNIZE THAT THERE–THERE ARE PROBABLY
QUITE A NUMBER OF PRACTICES PARTICIPATING IN OCM FOR EXAMPLE, THAT INVESTED SIGNIFICANTLY
IN THAT AND ARE ON OUR PATHWAY TO THAT IF WE’RE NOT ALREADY THERE.
AND IF YOU DESIGNATE CERTAIN PARTICULAR TOOLS, THAT COULD AGAIN TAKE TIME FOR IMPLEMENTATION
OF SOMETHING AND REPLACEMENT OF SOMETHING THAT MAY ALREADY BE WORKING.
THANK YOU FOR YOUR TIME.>>SO IT MIGHT BE HELPFUL FOR FOLKS SUBCOMMITTING
WRITTEN COMMENTS H H SUBMITTING WRITTEN COMMENTS TO LET US KNOW WHAT TRAOUPLTS THEY’RE USE
AND IF THEY HAD GOOD SUCCESS WITH THEM OR NOT SO WE CAN HAVE SOME SENSE OF THE DISTRIBUTION
WE MIGHT BE LOOKING AT.>>WILL DO.
>>YES?>>THANK YOU, THE NEXT QUESTION COMES FROM
JOHN HOLCOMB, WITH EASTERN CONNECTICUT HEMATOLOGY AND ONCOLOGY.
YOU MAY GO AHEAD.>>THANK YOU ACTUALLY WOULD THAT BE DAWN,
HOLCOLM. COUPLE QUICK POINTS.
ONE IS TALKING ABOUT THE EPROS, LOGISTICALLY, IT’S A GREAT IDEA, BUT LOGISTICALLY IT MAY
BE VERY DIFFICULT BECAUSE WHAT WE HAVE FOUND IS THAT MOST OF THE WORK TRANSLATIONAL RESEARCH
WE’VE HAD TO DO RELATED TO THE ONCOLOGY CARE MODEL, WE HAVE HAD TO DEVELOP OTHER SOFTWARE
MODELS TO CATCH SOME OF THAT DATA IT’S NOT ALWAYS LINED UP WITH THE EMRS, THERE HAVE
BEEN DIFFICULTIES WITH THE EIN, R VENDORS, TRYING TO FEED ADDITIONAL INFORMATION IN THROUGH
THE EMR SO WE HAD TO DEVELOP WORK AROUND. I KNOW THERE ARE SOME VERY GOOD PROS COLLECTION
TOOLS OUT THERE. BUT THEY ARE NOT EMBEDDED IN THE EHRS AND
IT WOULD BE A LOGISTICAL CHALLENGE TO TRY TO DO THAT, SO, I JUST–SET THAT FORWARD FOR
YOU TO THINK ABOUT IT BECAUSE WE MAY BE STRUGGLING TO TRY TO GET THE YOU THE INFORMATION YOU
NEED AND YOU DON’T KNOW HOW HARD A CHALLENGE IT IS FOR US.
BUT BEING ABLE TO TELL YOU HONESTLY, THAT WE CAN’T–DON’T ASSUME ANY OF THESE CHANGES,
WE ARE GOING TO BE ABLE TO ACCOMMODATE THROUGH THE EHRS THAT WE HAVE, THEY ARE PROBABLY GOING
TO HAVE TO BE BANDAGES AND [INDISCERNIBLE] THE OTHER THOUGHT I HAD THAT I WANT TO SHARE
WITH YOU, THE QUESTION ABOUT THE BUNDLING, MANY PRACTICES DO STILL EXIST IN CONSTATES
SUCH AS [INDISCERNIBLE] STATES AND THEY ARE NOT ALLOWED TO RADIOLOGY ONCOLOGY OR IMAGING
OR SOME LAB, THAT MAY BE RESTRICTED THORS SOEZ WHO RECEIVE THE SERIES POINTS–RECEIVE
THE CERTIFICATE IN THE STATE. SO NO MATTER THE BUNDLE YOU THINK BYOU IF
YOU ADD THOSE IN, YOU WILL NEED TO HAVE A BUNDLE THAT DOES NOT INCLUDE THEM UNLESS THERE’S
A WAY WE CAN FIGURE OUT HOW TO FORWARD PAYMENT TO AN ENTITY THAT IS NOT UNDER THE FINANCIAL
CONTROL OF PRACTICE. WHICH I DON’T THINK WOULD BE LOGISTICALLY
POSSIBLE AND I WILL APOLOGIZE BECAUSE I’M GOING TO BE GETTING ON A PLANE SOON AND BY
THE TIME YOU GET TO THE RISK, I MAY OR MAY NOT BE BE ABLE TO BE ON THE PHONE BUT I DID
WANT TO ADD A VERY QUICK COMMENT ABOUT THE RISK, AND THAT WOULD BE IF LESS THAN A MAJORITY
OF THE OCM PARTIC PLAN TO ANALYZE BY AGES STILL STANDING AT THE END OF THE PROGRAM HAVE
OPTED INTO TWO SIDED RISK, THAT IT MIGHT BE–YOU MIGHT WANT TO CONSIDER THAT IN ASSUMING THAT
THE NEXT MODEL IS JUST GOING TO AUTOMATICALLY END IT, YOU CHOOSE MINIMAL OR HIGHER TWO SIDED
RISK BECAUSE THERE WILL HAVE BEEN A REASON WHY A LESS THAN A MAJORITY WILL HAVE MOVED
INTO THAT. AND I HOPE WE CAN CONTINUE HAVE A CONVERSATION
ABOUT THAT. I’M DONE.
>>THANK YOU VERY MUCH FOR THOSE COMMENTS I THINK WE WILL TAKE ONE MORE AND I THINK
WE’RE GOING TO STOP ON PROJECTIS REDESEEN AND MAKE SURE, I KNOW WE’VE HAD PEPPERED COMMENTS
IN BUT I WANT TO MAKE SURE WE HAVE TIME ON THE PAYMENT AND RISK ARRANGEMENTS.
SO SO MAYBE ONE MORE COMMENT FROM THE PHONE IF IT’S ON PRACTICE REDESIGN?
>>THANK YOU. THE NEXT QUESTION COMES FROM DEBORAH LOPEZ
WITH CRYSTAL RUN HEALTH CARE, YOU MAY GO AHEAD.>>THANK YOU I’M DEBORAH, WITH CRYSTAL RUN
HEALTHCARE AND FROM NEW YORK AND MY QUESTION IS RELATED TO THE RISK, BUT I BELIEVE YOU
ARE GOING TO STEP INTO THAT AND IT’S SIMILAR TO THE DOCTOR WHO SPOKE RIGHT BEFORE, IF WE’RE
GOING TO BE AUTOMATICALLY PUSHED TO TWO SIDED RISK FOR THE DURATION OF IT, THEN THAT’S REALLY
NOT A CHOICE. MIRROR IMAGE SECOND QUESTION HAD TO DO WITH
THE QUALITY STRATEGY, OCM START WIDE 11 AND TAILORING RIGHT NOW TOWARD THE END OF IT WAS
REDUCED TO THREE, AND I’M READING THAT YOU’RE SAYING YOU ARE GOING TO USE THE SAME QUALITY
MEASURES, DOES THAT MEAN YOU’RE JUST ANYTHING TO GO IN WITH THREE?
OR IS IT GOING TO BE ALL 11 THAT YOU STARTED OCM WITH BACK IN 2016?
>>IT WOULD BE A CONTINUATION OF WHERE WE ARE CURRENTLY IN OCM.
NOT REVERTING BACK TO THE START.>>OKAY.
GOTCHA, THANK YOU. AND I’LL LET YOU STEP INTO THE RISK BECAUSE
I THINK EVERYBODY’S READY TO HEAR ABOUT THE OPTION.
>>[LAUGHTER]>>WELL THAT’S WHY WE ARE TALKING TO YOU GUYS,
I DON’T KNOW THAT WE HAVE ALL THE OPTIONS. OKAY, SO ANYTHING ELSE, ANYONE ELSE HERE IN
THE ROOM ON PRACTICE REDESIGN, THAT JUST CAN’T HOLD BACK?
>>MY COMMENT APPLIES TO ALL.>>YEAH, PLEASE.
>>SO [INDISCERNIBLE] COMMUNITY ONCOLOGY ALLIANCE, THANK YOU FOR THE LISTENING SESSION BUT THANK
YOU BELIEVE IT OR NOT FOR THE RFI ON FRIDAY BECAUSE YOU DID GET IT OUT BEFORE THE DECEMBER
THIRD DEADLINE FOR THE TWOD RISK WHICH WAS AN ASK AND THANK YOU VERY MUCH FOR THAT.
THANK YOU FOR INVITING THE COMMERCIAL PAYORS TO BE INVOLVED THAT’S BEEN PHENOMENAL AND
PROBABLY MORE SO THAN YOU REALIZE. THE GOOD NEWS IS, YOU HAVE SET THE PACE FOR
OTHERS TO FOLLOW, TO DATE WE COUNT ALONE 21 OTHER MODELS WHICH IS AWESOME THAT’S GOOD
BUT THE BAD NEWS IS THAT’S 21 DIFFERENT MODELS, I ENCOWAGE TO YOU LOOK AT COMPONENTS FOR TRANSFORMATION
ORIGINAL CARE DELIVERY OR MEASURES FOR PAYMENT METHODOLOGY FOR RISK, FOR SHARED SAVINGS,
ALL DOWN THE LINE, PLEASE KEEP THESE OTHER PLAYERS IN MIND JUST SO WE CAN GET SOME STANDARDIZATIONS
AS WE’RE ALL VERY ENTHUSED ABOUT THE REFORM AND WHERE IT’S TAKING US.
I AM WORKING–COA IS WORKING WITH ASCO RAOEBTLY. WE’VE HAD FIVE DIFFERENT VISITS TO COMMERCIAL
PAYORS SAYING WHERE ARE YOU IN THE PROCESS -FRPLT TWO THINGS THAT STOOD OUT CLEARLY,
ONE WAS THE NOTION OF TRYING ON FIGURE OUT HOW TO SHARE SAVINGS, THERE’S A REAL BIG EMPHASIS
RIGHT NOW FOR PRACTICE TO HISTORY TO PRACTICE PRESENT IS THAT MOVING THE BAR.
ALSO HEARD A COMMENT LAST FRIDAY OF A NATIONAL PAYOR TRYING TO FIGURE OUT THE DIFFERENT BETWEEN
GOOD, BETTER, BEST. WE’RE TRYING TO FIGURE IT OUT AND THAT’S WHERE
WE’RE ALL TRYING TO GO AND GET RECOGNIZED FOR THE BEST, LET THE RULES AND THE STANDARDS
BE AS CONSISTENT AND WHEREERB CAN PARTICIPATE. RIGHT NOW WE’RE SEEING WAY, WAY, WAY, TOO
MANY FLAVORS SO THAFRPBG YOU IF ARE WHAT YOU’RE DOING.
–A COMMENT ABOUT PAYMENT, I APPRECIATE THE FACT THAT
FOR THE MPP YOU TARGETED ON SERVICES THAT A PHYSICIAN CAN MORE DIRECTLY COAL, THAT IS
SOMETHING WE TALK TO YOU ABOUT IN THE PAST AND THAT’S FROM MANY OF THE PEOPLE IN THE
COMMENTS IN THE LAST FEW MINUES ABOUT THE IMPORTANCE OF KEEPING IT VERY NARROWLY FOCUSED.
I WOULD DRAW YOUR ATTENTION TO THE CAPPED SERVICES FOR YOURSELF, THAT MEANS THAT ANY
PARTICIPANT IN THE MODEL FROM DAY ONE WILL TAKE ON RISK FOR THE SERVICES THAT ARE INCLUDED
IN THE MPP SO EVEN IN THE ONE SIDED RISK METHODOLOGY, THERE WILL BE THIS ELEMENT OF IMMEDIATE RISK
AT A HUNDRED%, AGAIN FOR THAT NARROWLY DEFINED SET OF SERVICES.
FROM THE RISK YOU HAVE LAID OUT UNDER THE PDP, TOTAL COST OF CARE RECK, YOU PROPOSED
THREE DIFFERENT OPTIONS, THE FIRST BEING ONE SIDED FOR THE FIRST YEAR AND THEN AS YOU DISCUSSED
TWO DIFFERENT TYPES OF TWO SIDED RISK WITH VARYING DEGREES OF RISK.
I WOULD URGE YOU TO THINK ABOUT THIS MODEL AS BEING A NEW MODEL, EVEN THOUGH IT BUILDS
OFF OF OCM, BECAUSE THE INTRODUCTION OF A HUNDRED PERCENT CAPITATION ON A NARROWER SET
OF SERVICES AND THE REQUIREMENT THAT ANY PARTICIPANT IN OCM ENTER IMMEDIATELY INTO TWO SIDED RISK
COULD BE A DEAL BREAKER FOR MANY OF THE PRACTICES CURBENTLY IN OCM, SO WE HEARD ANOTHER SPEAKER
SAY CONSIDER WHAT WILL BE FOR YOUR TAKE UP. SO MY QUESTION FOR YOU IS ARE YOU OPEN TO
CONSIDERING A ONE SIDED RISK ARRANGEMENT FOR ALL PARTICIPANTS IN THE FIRST YEAR, AND IF
NOT HOW DO YOU PROPOSE TO INCENTIVIZE THOSE PRACTICES THAT ARE IN OCM THAT HAVE NOT TAKEN
ON THE TWO SIDED RISK AND THAT MAY IN FACT TERMINATE PRIOR TO THE TWO-SIDED RISK.
>>SO I THINK THAT WE ARE HAVING THIS SESSION SOEE CAN HAVE EVERYONE’S FEEDBACK.
WE INCLUDED THERE’S BEEN A THEME AND RISK ON THE INFOIVATION CENTERS AND MODELS, IF
YOU ARE FAMILIAR WITH THE BROADER ARRAY OF MODELS NOT JUST THIS PARTICULAR UNDERTAKING.
WE ARE–SO WHAT WE HAVE HERE IS THE KIND OF CARING OF RISK THAT WE WOULD DEFINITIVELY
THINK ABOUT IN OUR OTHER MODELS WHERE WE’RE LOOKING TO FIGURE OUT HOW TO BRING RISK AND
YOU HEARD THAN MITT STRAIGHTER SAY IT, TOO, TO THE DIFFERENT LEVELS OF THE DELIVERY SYSTEM.
SOME PEOPLE CAN’T TAKE A LOT, SOME PEOPLE CAN TAKE A LOT.
I THINK–I’M NOT GOING TO GIVE YOU A DEFINITIVE ANSWER, I WILL JUST SAY THAT.
BECAUSE WHAT I WANT TO DO IS HAVE SHOULD SESSION WHERE PEOPLE CAN TELL ULS WHERE THEY WOULD
LIKE TO BE WHAT THEY BEING THEY CAN DO, WE DID THINK IT WAS REALLY CRITICAL FOR PEOPLE
MAKING THE TWO SIDED RISK DECISION TO UNDERSTAND WHERE THIS CURRENT ADMINISTRATION RISK IS
IN TERMS OF THINKING ABOUT THE NEXT MODEL, NOW WE’RE HAVING A CONVERSATION SO WE CAN
UNDERSTAND MORE PEOPLE WANT TO BE, AND THAT IS ALL TAKEN VERY, VERY SERIOUSLY.
SO I COULDN’T EVEN TELL YOU WHAT I BEING THE FINAL ANSWER IS.
I DON’T KNOW IF THAT HELPS BUT I DO THINK WHAT’S IN THE PAPER IS AN INDICATION OF WHERE
WE WOULD START BUT I ALSO THINK IT’S REALLY CRITICAL FOR EVERYONE ON GIVE US THAT FEEDBACK
ON WHAT THEY WOULD LIKE TO SEE, WHAT THEY THINK’S IMPORTANT FOR THEM, WHAT THEY THINK
THEY COULD DO OR NOT DO, WE KNOW PRACTICE RESEARCH AREISS ARE AT ALL DIFFERENT LEVELS
OF COMFORT, WITH SOME HIGH, SOME LOW, SOME RUNNING AWAY, WE UNDERSTAND.
AND AT THE END OF DAY, IT IS A VOLUNTARY MODEL. SO NOBODY IS REQUIRED TO PARTICIPATE IN THIS
MODEL. AND THAT DOES HAVE SOME BEARING ON KIND OF
HOW WE LOOK AT WHAT WOULD BE REQUIRED ONCE YOU YOU KNOW ELECT TO COME IN.
>>THANKS FOR RESPONDING AND I KNOW YOU CAN’T GIVE A DEFINITIVE ANSWER, IT’S THE NATURE
OF WHAT WE’RE DOING, YOU CAN’T GET A DEFINITIVE ANSWER BECAUSE WE’RE COLLECTING COMMENTS TODAY.
I WILL PUT IN THAT YOU HAVE A ONE YEAR FOR EVERY PARTICIPANT.
>>THANKS.