Florida Cancer Specialists & Research Institute a Top Performer in the Center for Medicare & Medicaid Innovation’s Oncology Care Model

Lucio N. Gordan, MD

Florida Cancer Specialists & Research Institute, LLC, a consistent top performer among the 126 U.S.-based oncology practices that participated in the Center for Medicare & Medicaid Innovation (CMMI) Oncology Care Model (OCM), shares its results in the payment and delivery model’s final wave which ended in June 2022 in a newly released case study.

The intent of the OCM was to improve the quality and cost of care for oncology patients. Physician practices enrolled in the program were accountable for providing a higher quality of care at a lower expense by offering enhanced services for Medicare beneficiaries, such as care coordination, navigation, and adherence to national treatment guidelines for care. The model tracked financial and performance measures for episodes of care around the administration of chemotherapy to cancer patients.

In the final payment period (PP10) of OCM, Florida Cancer Specialists & Research Institute reported a net $24.3 million in cost savings to Medicare beneficiaries. Florida Cancer Specialists & Research Institute Medicare expenditures were 3.6% lower when compared to other OCM participating practices and 5.6% lower than all practices providing cancer care.

Florida Cancer Specialists & Research Institute established a care management program during the early waves of the OCM to improve coordination of care and assist with symptom management to help prevent unnecessary emergency department (ED) visits and hospitalizations, events that significantly drive up the cost of care. Efforts from this team effectively reduced inpatient admissions, observation stays, and ED visits throughout the duration of the OCM.

From inception through the current PP10 performance results, Florida Cancer Specialists & Research Institute has made advancements to transform care delivery throughout its participation in the OCM. The cost savings sustained stem from practice-wide efforts inclusive of adopting optimized clinical processes and technological advances to positively impact patient outcomes.

During this final OCM evaluation period, Florida Cancer Specialists & Research Institute experienced 18.3% fewer expenditures toward inpatient admissions, 1.6% fewer expenditures in observation stays, and 29.1% fewer expenditures in ED visits when compared to other participating OCM practices. Additionally, compared to all practices providing oncology care, Florida Cancer Specialists & Research Institute expenditures were 21.4% lower in inpatient admissions, 15.3% lower in observation stay, and 43.4% lower in ED visits.

Chemotherapy and precision medicine constitute a vast amount of oncology expenses resulting in approximately 65-70% of the benchmark threshold. Florida Cancer Specialists & Research Institute pioneered the utilization of biosimilar drugs and appropriate alternative therapies, a key factor to its success while participating in the OCM. PP10; the penultimate to the final reconciliation period resulted in approximately $24M in net savings to CMS.

“Biosimilars have been a true disruptor,” says Florida Cancer Specialists & Research Institute President & Managing Physician Lucio N. Gordan, MD. “Adhering to our mission of providing patient-centered care, we, as providers, must always do what is best for our patient. The introduction of these drugs alleviated a significant portion of the cost associated, without sacrificing the quality of care.”

Based on the outcomes during each of the ten determined payment periods, participating practices have an opportunity to experience shared savings with CMS should they meet or exceed the thresholds in place. Since the OCM’s inception in 2016, Florida Cancer Specialists & Research Institute has successfully reduced expenditures compared to the established payment methodology Medicare beneficiaries resulting in approximate $210 million and more than $98 million in net CMS savings.

“These results are a direct reflection of our team’s dedication to ensuring we continue to provide world-class oncology care to our patients. Years of planning, coordination, evaluation, re-evaluation and management over several systems within our practice have led us to the success we have experienced with the Oncology Care Model,” remarked Florida Cancer Specialists & Research Institute Chief Executive Officer Nathan H. Walcker. “In turn, we have been able to apply these learnings across the payer continuum, developing additional alternative payment models and mirroring similar quality and cost-saving initiatives so that all patients, no matter their coverage, have access to the best possible care.”

Florida Cancer Specialists & Research Institute has submitted its formal application to participate in the CMMI Enhancing Oncology Model (EOM), a voluntary five-year model, set to begin on July 1, 2023. True to its name, the EOM will build upon the quality and cost-saving requirements of the OCM, with an additional emphasis on addressing healthcare inequities. Upon receipt of the EOM Participation Agreement, Florida Cancer Specialists & Research Institute will diligently evaluate the EOM model to further value-based care in parallel to other Alternative Payment Models (APMs) across the payer continuum.