In 2020 the Association of Community Cancer Centers (ACCC) established the Alternative Payment Model Coalition to address concerns about lack of preparedness to perform under alternative payment models (APMs), patient and provider access to the latest treatments, infrastructure, and long-term sustainability. This coalition is inclusive of medical, radiation, and surgical oncology and all respective APMs, including the Oncology Care Model (OCM) and the proposed Oncology Care First (OCF) Model, the Merit-based Incentive Payment System (MIPS), Medicare Advantage, Medicaid Managed Care, and accountable care organizations (ACOs). Specifically, this initiative seeks to:
- Gain important insights into how APMs impact cancer care delivery, the oncology workforce, and patients
- Serve as a clearing house for tools and tactics for implementing and improving APMs
- Facilitate collaboration and sharing of experiences between cancer programs and practices related to APMs
- Continue to provide constructive feedback to APM developers, such as the Center for Medicare & Medicaid Innovation (the Innovation Center), about issues pertinent to cancer programs and practice
APM Implementation Checklist
As the health care industry moves from volume- to value-based care, readiness and strategies for APMs is top of mind for cancer programs and practices. In 2021, ACCC developed a checklist to help these programs and practices understand how their current capabilities align along the APM continuum from developing (ie, just getting started) to evolved (ie, years of APM experience). This tool can help determine the appropriate level of risk based on their existing capabilities and identify additional capabilities and competencies necessary to evolve and/or grow their APM strategy. To do so, cancer programs and practices will evaluate six key areas:
- Provider Network
- Care Delivery Transformation
- Effective Payment Models
- Provider Compensation
- Organization Foundation
Care Delivery Transformation
Each of these areas are mapped along a continuum from developing to evolved. So, for example, under Care Delivery Transformation, cancer programs and practices evaluate:
- Clinical Standards and Protocols
- Care Coordination
- Patient Engagement
Clinical Standards and Protocols
At a minimum, cancer programs and practices just getting started with APMs must have clinical protocols in place. Those with more APM experience should have evidence-based clinical protocols—including a standard review process—and have defined these clinical protocols across the care continuum. Those cancer programs and practices with years of APM experience under their belt not only have in place evidenced-based clinical protocols but they also ensure that their providers are aware of and adhere to these protocols. Moreover, these clinical protocols are defined across the care continuum and stratified on risk factors. Finally, cancer programs and practices experienced with APMs will regularly review and update their clinical protocols.
Cancer programs and practices entering into APMs must have care management services that are shared across organizations, as well as offer referral management and patient navigation to help improve care coordination. Those looking to expand use of APMs generally share care management services across service lines, standardize care transitions within their organization, and coordinate with emergency departments. Finally, cancer programs and practices with years of APM experience generally have care management services dedicated to the oncology service line, standardized care transitions across care settings, and ongoing care coordination among providers across the entire care continuum.
At a minimum, cancer programs and practices just getting started with APMs must conduct patient experience surveys. Those looking to expand their use of APMs will generally need to target their patient engagement strategy to specific initiatives, ensure that patient experience survey results support that engagement strategy, and track patient-reported outcomes (PROs). Cancer programs and practices with APM expertise generally have in place a comprehensive patient engagement strategy, forums such as Patient and Family Advisory Councils, and a process to identify actionable items based on their identified PROs.
Next Steps on the APM Journey
This APM Implementation Checklist is not a comprehensive tool but instead should be used to supplement ACCC’s 2020 APM eLearning modules. The eLearning modules—which highlight real-world case studies—align with the six key areas identified in the checklist, and provide more details about implementation, including the sequencing and pacing of care transformation. These resources are available on the ACCC eLearning portal at accc-cancer.org/apmc-elearning-modules.