An update to the American Society of Clinical Oncology (ASCO) Patient-Centered Oncology Payment (PCOP) model involving recommendations for the creation of an alternative payment model involving participation of geographic communities of PCOP stakeholders was published in JCO Oncology Practice.1
Originally released in 2015, the ASCO PCOP model was designed as a flexible plan that was built on the principle of improving patient outcomes by improving cancer care delivery and coordination.
With initial goals of addressing the increasing financial burdens of cancer care on patients with cancer and their families, as well as alleviating some of the administrative loads of oncology practices regarding the integration of health care utilization review, the ASCO PCOP model paired a plan for monthly care management payments for particular oncology services, as opposed to fee-for-service reimbursement, with a focus on the delivery of high-quality care in 4 areas: “avoidance of emergency room visits and hospital admissions; adherence to evidence-based appropriate-use criteria; patient-directed end-of-life care, and quality-of-care performance.”
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Based on feedback received since the release of the original version of the PCOP model, it was amended to incorporate standards related to the oncology medical home,2 and address issues related to the participation of multiple payers, requirements related to care delivery, practice utilization of evidence-based clinical treatment pathways, and approaches to the measurement of the cost of cancer care.
Since the use of different performance measures by different payers for the purpose of gauging the quality of cancer care can result in oncology providers being subjected to a high administrative burden, one element of the updated PCOP model involved “multipayer, multipractice participation” in PCOP communities made up of “all payers, providers, employers, and other stakeholders within a geographic region, which guide implementation and operation of the PCOP methodologies.”
In addition to allowing for a harmonized version of quality metrics, PCOP communities would work together to select clinical practice guidelines on which to base treatment decisions, as well as the quality improvement projects for PCOP community participation.
Similarly, members of a PCOP community would deliver health care according to a common set of requirements related to patient engagement, availability and access to care, comprehensive team-based care, quality improvement, safety, evidence-based medicine, and technology.
The updated version of the PCOP model also outlined the principles related to the quality and cost of cancer care on which the performance of PCOP communities would be evaluated. In addition, a care management payment methodology, based on patient-, disease-, and treatment-related characteristics was also described.
In summarizing the ASCO PCOP model, the authors of the updated version described it as “a comprehensive alternative payment model that enhances both the patient experience and quality of care. It prepares providers for full practice transformation, incentivizes participation in a value-based reimbursement system, and positions practices to succeed in a rapidly changing care delivery environment.”
References
- Ward JC, Bourbeau BR, Chin AL, et al. Updates to the ASCO Patient-Centered Oncology Payment Model. JCO Oncol Pract [published online April 17, 2020]. doi: 10.1200/JOP.19.00776
- Waters TM, Kaplan CM, Graetz I, et al. Patient-centered medical homes in community oncology practices: Changes in spending and care quality associated with the COME HOME experience. J Oncol Pract. 2019;15:e56-e64.
