Ready or Not: Assessment of Readiness for Oncology Value-Based Care Program Participation

A pre-requisite for participating in risk-bearing oncology value-based care (VBC) programs like the Enhancing Oncology Model (EOM) is that prospective participants comprehensively understand program requirements, risk/reward, and processes that will impact success. It can be challenging for community oncology practices with limited resources to dissect, understand, and implement sustainable VBC program processes if analytics or transformation support is unavailable.

Upon receipt of the EOM program specifications, The US Oncology Network (The Network) Transformation & Quality team created a readiness assessment to evaluate key program requirements and capabilities including eligibility, enrollment & billing, provision of enhanced services, quality measurement, clinical & staging data curation, sociodemographic data capture, comorbidity capture, total cost of care control, drug initiative implementation, and risk management. On-site and virtual assessments were conducted with practices in The Network, evaluating current processes and identifying gaps. The assessment evaluated the return on investment for implementing care transformation or hiring additional staff against potential revenue and incentives from the program. Practices also considered the risk/reward from the program.

Twenty-three practices engaged in readiness assessments to evaluate participation in the EOM. Pre-model readiness scores ranged from 15%-85% with an average of 49%. Managing drug initiatives scored the highest average at 70%, while managing eligibility and enrollment & billing scored the lowest average at 37%. Practices with prior VBC program experience (Oncology Care Model [OCM] or commercial VBC) had higher readiness scores for EOM participation. At the conclusion of the assessments, practices reported improved understanding of the EOM requirements and resource needs for program success. Ultimately, 12 practices decided to participate in the EOM with go-live on July 1, 2023. EOM participating practices scored an average readiness of 64% compared to 35% for nonparticipating practices during the pre-model assessment. After 90 days of EOM participation, the average readiness score for the 12 participating practices was 89%. Most improved scores 90 days into the EOM were in eligibility, enrollment & billing, and quality measurement categories.

Conducting a thorough and systematic evaluation of practice readiness for VBC programs empowers practices to make informed decisions about VBC model participation. It is crucial to carefully assess model components, resources, and investments necessary for successful implementation and sustainability. Readiness assessments are crucial for newer models that involve at-risk participation but can also be valuable for non-risk VBC programs and ongoing process improvement.

Authors:

Jessica Neeb, MSN, RN, OCN, Senior Director, Transformation and Quality¹; Puneeth Indurlal, MD, MS, Vice President, Practice Operations²; Sharon Hart, Senior Manager, Transformation and Quality¹; Dana Weber, MSN, RN, Senior Manager, Transformation and Quality¹; Lalan Wilfong, MD, MS, Senior Vice President, Value Based Care³; Stuart Staggs, Vice President, Transformation and Quality¹; Judi Payne BSN RN, Senior Director, Clinical Services¹

Affiliations:

¹The US Oncology Network, The Woodlands, TX

²The American Oncology Network, Fort Myers, FL

³Thyme Care, Nashville, TN