Texas Oncology streamlines operations to achieve success in Medicare value-based payment model

• The experience of Texas Oncology in CMS’s Oncology Care Model shows how provider organizations can use change management processes to lay the foundation for success in new care delivery models.
• The organization established a core team to lead the implementation of value-based payment models.
• The core team employed an internal communications strategy to make optimal use of data analytics to better coordinate care and integrate updated processes into provider workflows.

After examining opportunities to enhance care and reduce variation, Texas Oncology entered Medicare’s Oncology Care Model (OCM) in 2016. Participants must demonstrate improvement in care for Medicare beneficiaries throughout six-month episodes that start with chemotherapy treatment. The program requires the use of data to inform decisions as part of incentives for providers to enhance care quality.

In its fourth year of participation, Texas Oncology has seen improvements in areas such as patient navigation and unnecessary hospitalizations. The organization attributes its success to tactics ranging from the strategic use of staff resources to investments in technology to restructured communications.

Key considerations for implementation

At Texas Oncology, 685 providers — 527 physicians and 158 advance practice providers — are participating in the OCM. To engage staff resources, the organization implemented a value-based care team, developed a communications strategy and invested in technology.

A core team was organized to facilitate implementation of value-based care models. The following roles are represented:

• Physician lead
• Operations lead
• Director of nursing
• Director of social work
• Project manager
• Data coordinator
• Administrative assistant

The organization mostly repurposed or expanded the roles of staff already employed to these positions, allowing them to focus on the value-based care program, and established the role of data coordinator. Creation of this cross-functional team has aided the development of processes and procedures in areas such as data collection, metrics review and provider engagement.

“There’s no way we could achieve success in the program without this team helping ensure we’re managing the project well,” said Lalan Wilfong, MD, vice president of quality programs and value-based care at Texas Oncology, who serves as physician lead for the core team.

Lalan Wilfong, MD, Texas Oncology

To secure early buy-in from leadership, Wilfong’s team highlighted opportunities to create revenue, improve care and reduce utilization in the OCM’s one-sided risk option. To educate providers about OCM requirements and potential benefits, Wilfong hosted webinars and traveled to Texas Oncology’s physician sites to conduct face-to-face presentations and meetings.

Investment in technology is another consideration when planning to participate in value-based care models such as the OCM. “Addressing the high cost-drivers is important,” said Charles Saunders, MD, CEO of Integra Connect, which works with 10% of the organizations participating in the OCM (not including Texas Oncology). “And the tools that can drive success are having technology and analytics to look at the claims experience and clinical data to help understand performance in terms of cost, utilization and quality.”

Texas Oncology has relied on data to identify specific causes of variation. “With the claims-based data there’s a wealth of information about the patient, including when they’re going to the hospital, which hospital they’re going to and who’s going to the ER,” said Terry Jensen, director of value-based care at Texas Oncology, who serves as the core team’s operations lead.

Engaging staff to improve care and reduce variation

Data analysis revealed opportunities for improvement in patient navigation and physician workflows. The core team employed an internal communications strategy to use this information to better coordinate care and integrate updated processes into provider workflows.

Before entering the OCM, Texas Oncology handled phone calls differently across each site, and data indicated correlations between lengthy call-waiting times and unnecessary hospitalizations. The core team shadowed staff to pinpoint specific issues and supported investment in a third-party vendor to streamline calls and scheduling, resulting in a reduction in call volume by one-third.

After examining staff roles and responsibilities, Texas Oncology reorganized resources to more efficiently field patient calls. The organization also created care coordination teams that hold weekly huddles to discuss high-risk patients. Emphasizing proactive outreach to patients helped reduce admissions.

“Instituting these huddles has been a great morale booster for the team,” Jensen said, “because staff have a place to be heard, and they’ve realized the importance of care coordination.”

Terry Jensen, Texas Oncology

Using an intranet platform, the core team regularly posts OCM metrics, encouraging friendly competition when possible. The team also hosts regional calls to review performance metrics of participating providers. Such tactics have helped reduce hospitalizations by 3.1%.

Texas Oncology has invited feedback and aimed to be nimble when processes don’t work as anticipated. For instance, documentation of pain management, as is required of OCM participants, obligated participating providers to search for a particular field in the EHR.

“We created a field in our EMR documenting how the physician managed pain, but it was buried,” says Wilfong. “Physicians were willing to click that extra box but didn’t want to search for where to click.’”

As a short-term solution, Texas Oncology added a function that better notifies providers to log their approach to pain management. The organization has also invested in an updated EHR that will roll out this fall. Among the features is a widget that reminds physicians of unfinished tasks for the day.

Building on lessons learned

With Medicare and commercial payers aiming to shift more risk to providers, Saunders said any organization considering participation in a value-based payment model should prepare ahead of time. “Organizations need to understand what they’re getting into from a financial standpoint, looking at what they can do to reduce costs and programs they can put in place to help address that,” he said.

Entering the OCM one-sided risk model allowed Texas Oncology to build a foundation for taking on additional risk. When exploring whether to participate in the two-sided risk version last year, the value-based team relied on feedback from an actuary. The actuary noted the likelihood of success due to revenue from performance-based payments and because of the anticipated adjustment to the price benchmark. The projected risk of financial loss was low.

Texas Oncology has been participating in the OCM’s two-sided risk model since July 2019, building on the processes and procedures it established to promote cross-functional collaboration and accountability. “The OCM has brought us together as a practice,” Wilfong said, “where we’ve recognized it’s all of us together working, not just individual people.”