Florida Cancer Specialists & Research Institute Calls for Reform in Value-Based Oncology Care Programming

Lucio N. Gordan, MD

Florida Cancer Specialists & Research Institute, LLC (FCS) is calling for reform in value-based oncology care modeling and proposes a holistic approach to gain a comprehensive understanding of drivers for improved outcomes in oncology practices. In today’s current value-based care landscape, risk-reward ratios are often offset by rising drug and procurement costs and poorly aligned goals with reduced cohort sizes and limited attribution pools.

Following the statewide practice’s success as a top performer of the Centers for Medicare and Medicaid Innovation Center (CMMI) Oncology Care Model (OCM), FCS has applied best practices observed during its participation in the five-year value-based care (VBC) program and has since sought out payer partnerships emulating similar processes and services that were effective in reducing healthcare costs and improving patient outcomes.

“We are deeply committed to driving strategic value-based oncology care efforts at FCS. Building on our previous success in the OCM, we are poised to further elevate patient outcomes and reduce costs. By aligning incentives with quality metrics and fostering collaboration across the care continuum, we aim to set new benchmarks for excellence in oncology care delivery,” says FCS Chief Executive Officer Nathan H. Walcker.

FCS has identified the key factors that directly impact value-based oncology platforms:

Attribution

Significant limitations on cohort pools impede the goal of achieving comprehensive and impactful models. Moreso, bespoke models with limited attribution pools place the burden of attribution complexities directly on providers. Expanding appropriate cohort representation ensures appropriate patient diversity and representation. The OCM, for example, observed 21 various cohorts and provided a broad depiction of the types of cases presented.

Benchmarking & Creating Prospective Value

To ensure long-term success of a program, VBC models must embrace benchmarking with a large enough ‘safe zone’ that accounts for the evolving cancer landscape and ensures alignment with up to date & real-time cost dynamics. Alternative payment models often stretch the assumption of unrealistic discounts to target and set the reward mechanism. Doing so implies that oncology providers have the ability to reduce costs.

Scalability

VBC programs must have buffer zones that allow for an acceptable margin of error. Adjusting models to include broader cancer-type inclusion and an aggregated performance approach allows for precision and scalability. It also recognizes the inherent variability in recent market trends and rapid shifts in drug-practice patterns. Oncology providers will continue to have difficulty in meeting unrealistic benchmarks, especially for cancer types lacking biosimilars or therapeutic equivalents at a lower cost. VBC Programs must navigate the complexity of measuring drug costs in a rapidly shifting environment.

Key Considerations for Successful Risk Models

• Expand Cancer Type Inclusion: Increase risk spread & focus on high-quality & inclusive care for all patients.
• Benchmarking Enhancement: Utilize thresholds for larger ‘safe zone’ & measure the evolving cancer landscape in benchmarking.
• Drug Landscape: Harbor flexibility to adapt methodologies & benchmarks that coincide with emerging drug trends.
• Capital Investment: Provide upfront per member per month (PMPM) revenue to providers for capital investment, ensuring health equity for all patients.

Uncharted Waters of Holistic Oncology Care

FCS has been steadfast in its efforts to reinvent the approach to cancer care through a patient-centric focus while seeking new methods to reduce costs. The statewide practice recently implemented its value-based care program, the FCS Holistic Model of Care, which was developed in partnership with referral partners, primary care providers, and health plans. Utilizing performance-based quality metrics and care coordination programs, this new model tailored to patients is standardizing clinical care to the highest, evidence-based standards.

“Through our holistic, value-based approach, we have the ability to establish best practices that enhance outcomes and reduce the costs associated with providing care,” says FCS President & Managing Physician Lucio N. Gordan, MD. “Adhering to programs that embrace scalability and flexibility and promote a win-win-win scenario for payer, provider and patient is ideal and possible. We’ve had great success when these factors are considered and are experiencing newfound benefits from our Holistic Model of Care.”