Publication

The Centers for Medicare and Medicaid Services (CMS) has recently reiterated its commitment to transition more providers to two-sided risk alternative payment models (APMs). Ever mindful of CMS’s direction and leadership in payment reform, oncologists and commercial payers developing their own APMs in oncology are increasingly focused on the role of risk in incenting a shift to value-oriented care without threatening practices’ financial viability. The question of whether and how much risk is needed for accountable care was top of mind for participants in the oncology APMs advisory council, which gathered in March 2019 in Washington, DC. The council serves as a platform for leading designers and implementers of oncology APMs to learn from one another and catalyze new thinking and approaches to
improve pilots in this space. The broad issue of accountability in oncology care underlay other meeting topics. These included the need to meaningfully measure provider performance and inducing effective care delivery through use of clinical pathways, which are quality-focused treatment protocols for specific types and subtypes of cancer.

During the meeting, participants considered the following questions:

•  In two-sided risk models, can reinsurance2 protect practices from catastrophic loss?
• How can outcomes-based quality measures be practically implemented?
• What is the near-term direction for clinical pathways in promoting effective, value-based
  care?
• What new APMs are being developed? And do they still matter in today’s dynamic policy
  environment?

To address these questions, the council welcomed experts from Milliman and the Tufts Center for the Evaluation of Value and Risk in Health (CEVR) to share findings from new research on the value of reinsurance and outcome measures, respectively.