CPC & CBEx 2024: Managing Clinical & Financial Risk in Oncology

A group of oncology practice innovators and care platform disruptors spoke as part of a session at the 2024 Clinical Pathways Congress + Cancer Care Business Exchange about managing clinical and financial risk in oncology.

Christopher Day, chief strategy officer, IntegraConnect, began the session by providing an overview of how risk works in the oncology space. Essentially, risk is what providers are financially accountable and responsible for. There are also risk-bearing entities (RBE) that take on financial risk for the care of a specific group of patients. “We have to meet Centers for Medicare & Medicaid Services (CMS) measures, but we also have to write a check when we don’t meet them—the risk,” said Day. He emphasized the need for providers to show evidence of how they are attaining their operations and financial goals. Business and clinical strategies should be aligned with the risk being accepted.

The oncology practice innovators then joined the conversation by sharing different strategies for managing risk. Jessica Neeb, MSN, RN, OCN, senior director, Transformation & Quality, US Oncology Network, noted that having in-house expertise—such as their clinical services team, pharmacy solutions team, and impact analytics team—is helpful to support network practices. They use these resources to asses what the practices’ appetite is for risk and to look at what the requirements of the program that they’re working with vs what they have in their practice already. What do they need to purchase, what resources do they need, or do they need to partner with someone to be successful in that program?

For institutions that do not have these services in-house, Alti Rahman, MHA, MBA, CSSBB, chief strategy & innovation officer, American Oncology Network (AON), discussed how although there is a disparity in services available from state to state in their network (urban vs rural or the size of practices), they have a central management system and an informatics division. In this division, they use a pushed-based principles method to get physicians relevant information on what matters in their value-based care program.

Moderator Ira Klein, MD, vice president, Provider Relations, Tempus Labs, noted that sometimes institutions have to pivot their approaches to better manage their risk. Lora Markley, regional director, Managed Care Contracting, Specialty Provider, US Oncology Network, discussed the importance of stakeholder—both internal and external—engagement and feedback when implementing or changing procedures to adhere by value-based care models. “You have to think about all the various finites. Have honesty and integrity with partners and stakeholders to go back and iron things out. Listen to everyone’s thoughts and concerns and be open and candid and have difficult discussions or it’ll come back to bite you,” said Markley.

Finally, the care platform disruptors, or RBEs, discussed how they “disrupt” or manage financial risk for their partners. Bobby Green, MD, co-founder, president, and chief medical officer, Thyme Care, stated that the field of oncology has generally been left out of health plan-sponsored value-based care, which is where their partnership with RBEs fill in the gaps. Thyme Care considers themselves a value-based care enabler and is partnered with several RBEs, including Oak Street Health. Their methods include deploying two interventions around a defined population of actively-treated cancer patients that they have taken on the risk for. This includes a virtual navigation services that can address social determinants of health [SDOH] and work with palliative care needs, as well as sharing savings with oncology practices they partner with.

Panel members noted that the move toward value-based models has generally been slow in oncology.  Partnering with primary care groups are a great source for learning about value-based care, referrals, and creating a much better patient journey, said Day.

Reference

Klein I, Day C, Neeb J, et al. Managing Clinical & Financial Risk in Oncolo. Presented at the Clinical Pathways Congress; September 6, 2024; Boston, MA.