By Gregg A. Masters, MPH
The best business model for oncology care is not yet obvious to me. But it is crystal clear that innovative new models are being hatched before our eyes.. via Oncology Times
Since CMS (via HHS) issued the final rule addressing ACO provisions and specifically ‘excluded’ oncologists from participating as ACO organizers, instead relegating their involvement in at least via the Medicare Shared Savings Program to ‘participants’, there has been rumbling underneath the surface of ‘ACO-dom’.
Perhaps as best evidenced by the April announcement of a tripartite venture between FlordiaBlue, Advanced Medical Specialties (a former US Oncology Affiliate now part of the McKesson fold), and Baptist Health System, the competitive positioning in the oncology market is not sitting idly by as other medical specialties, including primary care, carve out their niche and actively experiment with their version and local vision for accountable care aka ‘the triple aim.’
In the broader conversation on ACOs or their derivatives including medical homes or accountable care collaborations, etc, there has been much discussion from very smart and accomplished wonks including periodic banter, i.e., Goldsmith v. De Marco] as to the significance and forward [reasonably expected] benefits from duly organized [or in the latter case – arranged] ACOs. Bottom-line, there is a fair amount of credible disagreement over whether these entities as variably configured actually make a difference?
Meanwhile, in the oncology domain, much of the action seems relegated to a few forward thinking players who have taken the initiative regardless of CMS’ decision to limit their participation (at least to this point in time) to contracted participant suppliers of specialty services.
For a deeper dive into the question: ‘Who Is Taking the Lead in Incorporating Oncology into ACO Thinking?’ see: The Rapidly Evolving ACO World, we have the following observation and summary data:
There are several examples of organizations that have stepped up and have taken the lead in exploring payment re-design in oncology, some within an ACO shared savings context and some outside the ACO context.
The vanguard includes:
- Consultants in Medical Oncology & Hematology. Oncology Patient Centered Medical Home®, Drexel Hill, PA
- United Healthcare (5 episode payment pilot sites)
- Texas Oncology/Innovent Oncology and Aetna
- Oncology Physician Resource (OPR) and Michigan Blue Cross
- Wilshire Oncology and Wellpoint, Southern California
- CareFirst Blue Cross pathways and medical home initiative, Maryland
- Priority Health oncology medical home initiative, Michigan
- Florida Blue, Baptist Health South Florida and Advanced Medical Specialties Oncology ACO, Miami
- Harvard Pilgrim Health Plan with oncology medical home demonstration pilot, Massachusetts;
- Innovative Oncology Business Solutions with CMMI Innovation Challenge grant to demonstrate value proposition of community oncology medical home (COME HOME) at 7 community oncology practices nationwide.
And certainly there will be more organizations joining the vanguard in the near future.
We are working on getting Ronald Barkley, CCBD Group, and Linda Bosserman, MD, President and CEO of Wilshire Oncology respectively to share their thoughts on ‘This Week in Oncology’. We’ll keep you posted when we’re able to lock them down.
Meanwhile, with the elections now behind us, the future is rather clear at least for those who want to manifest the spirit and intent of the Affordable Care Act, so ‘warp drive Mr. Zulu’ as the ACO movement shifts into overdrive.
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