Nov 26, 2019
Today ASCO released a major update to its Patient-Centered Oncology Payment (PCOP) model, an alternative payment model designed to support transformation in cancer care delivery and reimbursement while ensuring that patients with cancer have access to high-quality, high-value care. The updated model reflects lessons learned from previous demonstration programs, including a PCOP pilot in New Mexico.
ASCO's oncology-specific model is uniquely positioned to confront care delivery challenges in an increasingly complex medical specialty. It addresses an array of pressures facing cancer care, including the growing financial burden on patients and families and increasing administrative burdens on practices as a result of expanding utilization management requirements. The PCOP update comes after more than 5 years of work by ASCO volunteer groups, including leading medical oncologists from diverse practice settings, seasoned practice administrators, payer representatives, and experts in physician payment and business analysis.
"As oncologists, we have a responsibility to shape the future of America's cancer care system," said 2019-2020 ASCO president Howard A. "Skip" Burris, III, MD, FACP, FASCO. "We're stewards of our patients' wellbeing, and ASCO's model reflects everything we have learned in over 50 years of work to advance patient care. It is a complete solution for transforming cancer care delivery and reimbursement and puts the needs of patients front and center."
ASCO's model transforms cancer care using three major approaches: improved care delivery and coordination through an oncology medical home framework, which has shown improved outcomes and reduced costs; a performance-based reimbursement system that relies on patient-centered standards and transitions to bundled payments; and consistent delivery of high-quality care using clinical pathways that adhere to ASCO criteria.
Inherent in the PCOP design is its emphasis on implementing PCOP in "communities"—multidisciplinary networks of oncology providers and practices; federal, state, and private payers; employers; and regional health networks—aligned to support patient-centered care. This focus provides the following benefits:
- For patients, it offers access to an enhanced patient experience and state-of-the-art cancer care.
- For providers, it enables a successful transition to value-based systems.
- For employers and health plans, it offers a powerful way to incentivize quality and constrain costs.
Modeling all-payer data from the Maine Health Data Organization, ASCO has projected significant potential for PCOP to yield cost savings—up to 8% across the health care system. The model accommodates diverse practices and care settings and is designed to guide participants through the implementation process.
ASCO will include PCOP as part of its response to the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation's recent Request for Information about next steps following the completion of the agency's Oncology Care Model (OCM) in 2021. PCOP offers a way to expand on the OCM experience and would be an appropriate next step in innovation following conclusion of the OCM performance periods.