ASCO Updates Its Oncology Medical Home Payment Model

The American Society of Clinical Oncology (ASCO) recently released a major update to its Patient-Centered Oncology Payment (PCOP) model, an alternative payment model designed to enable all oncology practices to deliver higher-quality care at lower cost. The update comes more than 5 years after ASCO released its first model and incorporates feedback from medical oncologists in diverse practice settings, as well as practice administrators, payer representatives, and experts in physician payment and business analysis.

ASCO 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 the Department 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 designed 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,” the organization noted.

PCOP would be community-based, meaning that it 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,’ which are aligned to support patient-centered cancer care.”

If implemented as a single-payer model, ASCO is encouraging payers to maintain the stakeholder collaboration components of the PCOP model.

The new PCOP model uses 3 significant approaches to transform care delivery while ensuring high-value patient 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 the 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, Chief Executive Officer, ASCO, and Stephen S. Grubbs, MD, Vice President, Clinical Affairs, ASCO, in the submission letter to the PTAC.

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

  • 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.

For patients, the PCOP would mean increased access to an enhanced patient experience and state-of-the-art cancer care. For providers, the PCOP design would enable a successful transition to value-based systems. Finally, for employers and health plans, it would offer a way to incentivize quality and constrain costs.

Under the proposal, providers could enter 1 of 2 tracks. Practices that 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 practices (track 2) will participate in Consolidated Payments for Oncology Care. 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 Consolidated Payments for Oncology Care, 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. These cost-of-care data are meant “to identify opportunities to deliver high-value care, abandon low-value practices, and invest in a more efficient delivery system,” according to ASCO.

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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