Maximize Revenue And Outcomes: Why Oncology Practices Must Adopt Value-Based Care (VBC)
For years, the healthcare industry in general and oncology practices in specific clung to the fee-for-service approach in billing. And it worked for them pretty well. But now, circumstances have changed. Treatment costs have soared. Delivery systems have become more fragmented. And patient outcomes have become more inconsistent.
This is where value-based care comes in. It is the model to bring fundamental changes in how oncologists, payers, and health systems can form an ecosystem where there is a nice balance between quality treatment provision and reimbursements.
Why The Need For VBC Came Up
The recent advancements surely have made cancer care more effective and diversified. But they also have brought significant challenges. Treatment drugs have become more expensive and care delivery more complicated. Choosing the right treatment has become more difficult for practitioners and hospitals. The reasons are the following:
- Back in 2001, the cost of cancer care globally was $57 billion. Today, it is around $200 billion. Rising treatment costs do account for this price surge, but unnecessary emergency visits and hospitalizations are also the major culprits.
- The quality of patient care is not the same across all providers and treatment settings. That’s because quality frameworks are non-existent. The resultant gaps in patient care lead to poor outcomes.
- Transportation and financial issues can restrict patients' access to cancer care. And they fail to get quality treatment on time. This ultimately affects the overall patient experience and outcome.
These issues raised the need for a dedicated framework that could ensure quality care without creating revenue constraints for providers. Value-based care is that framework.
What Value The Value-Based Oncology Care Has Brought
As mentioned above, VBS focuses on patient care quality. Under this framework, the regulatory bodies promise providers incentives for ensuring quality care. The major quality criteria include patient satisfaction and a reduction in unnecessary visits. There is a stark contrast between both these requirements, which means providers must go in with a balanced treatment strategy.
VBC also adds payers to the loop. But again, the responsibility falls upon the providers to work with their payers in setting goals, formulating payment incentive programs, and tracking the performance of treatment plans.
The top benefits of this model are as under:
- Improved outcomes: Adhering to quality metrics enables providers to become proactive with patient care. This can help reduce the need for many emergency therapies. Patients get their treatment before it’s too late.
- Enhanced patient experience: VBC mainly focuses on personalizing the entire treatment plans instead of reimbursing for individual services. This patient-centric approach increases satisfaction and engagement.
- Financial benefits for complicated treatment plans: Complex treatments are not without financial implications. That is why practitioners often hesitate to initiate these treatments. VBC makes it easy by incentivizing providers for bringing efficiency, reducing wastage, and providing preventative care.
Government Programs That Support VBC
The government’s initiative to make healthcare more value-driven is not new. Authorities have been guiding and funding institutions to ensure adoption of value-based care models for many years.
The CMS Innovation Center
Almost all reimbursement reforms come from CMS. Their particular CMMI program regularly develops and tests payment models that focus on improved care quality at reduced costs. Their initiatives in oncology care include:
- Oncology Care Model (OCM): This program was launched in 2016 to promote coordinated cancer care. The main intention behind this program was to make providers accountable for cost and quality. For this, it linked performance-based payments to outcomes. This program was discontinued in 2022.
- Enhancing Oncology Model (OEM): Introduced in 2023, this model focuses on care coordination, patient engagement, and broader health quality measures. It incentivizes practices to provide value-based care to cancer patients under Medicare.
Alternative Payment Models (APMs) And Bundled Payments
APM is another model that ties financial risk and reward to the care value. In oncology, this model governs bundled payments, which refer to fixed amounts for entire treatment episodes rather than individual treatments. The particular protocol for such payments is Bundled Payments for Care Improvement (BPCI).
Merit-Based Incentive Payment System (MIPS)
This program is the most comprehensive VBC model. Being a part of the QPP, this program links payments to:
- Patient outcomes
- EHR usage efficiency
- Clinical improvements
- Cost efficiency
This model uses a specialized scoring system that rates a practice’s performance in all four areas. The practice is then incentivized or penalized based on the mean score.
Implementation Challenges In Value-Based Oncology Care
VBC models are relatively more complex than fee-for-service systems. And in the case of oncology, the complexity can be exponential. The top challenges cancer care centers face in this regard include:
- Lack of resources and investments: This is rightfully the most significant issue for oncologists. Shifting to value-based care requires major investments in terms of money and time. Most practices fail to get this prerequisite fulfilled.
- Dynamic requirements: There is no standardized way to implement VBC models. And if we look at the number of cases the oncology practices currently deal with, such standardization seems out of question in the future as well. So the only way practices can successfully implement this model is to identify their unique needs and work with revenue experts to proceed with their adaptation plans.
- Scarcity of Available Data: Since not many practices have yet adopted VBC models, the available analytics may not be much enlightening about the program’s success rate. Or at the very least, the data may not be easily interpretable for common users. This again raises the need for revenue experts who can identify trends and patterns in the available analytics and suggest accurate actions.
How To Implement Value-Based Care In Oncology
The most effective way to provide value is to streamline your practice and keep your resources intact. A stable revenue stream will help you save enough resources to go through this major shift without disruption.
At AltuMED, we provide expert RCM services that help you achieve your revenue goals. Our financial specialists have particular expertise in MIPS and QPP reporting. And our billing services take the burden off your shoulders so that you can focus more on patient care. That fulfills the crucial requirement for value-based care.
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