Transcript: ASCO-COA Oncology Medical Home Model Provides Standards for High-Quality, Evidence-Based Care

Gordon Kuntz: Welcome to Oncology Innovations, a Journal of Clinical Pathways podcast focusing on candid conversations with innovators aiming to advance quality and value throughout the cancer care ecosystem. I'm your host, Gordon Kuntz. I'm a consultant with almost 20 years of experience in oncology clinical pathways and the business of oncology. I've worked with oncology practices, pharma, payers, GPOs, and pathway developers, basically every aspect of the oncology ecosystem, and I've met some really interesting people along the way.

I'm very excited about today's podcast because I'm joined by Bo Gamble of the Community Oncology Alliance. I've had the pleasure of knowing and working with Bo for about 10 years now. I feel like everyone knows Bo, but just in case, he has been a leader in defining and measuring quality in oncology through COA since 2011. He was instrumental in putting together COA's payer summit, and we collaborated on some early work in quality measurements in oncology medical home and patient satisfaction. So it has been no surprise that Bo is smack in the middle of ASCO-COA's medical home model that we're going to talk about today. Welcome Bo.

Bo Gamble: Thanks Gordon. It's good to be with you today.

Gordon Kuntz: Great. I've got a number of questions. I want to talk about this COA-ASCO oncology medical home model. First off, tell us a little bit about it. What is it and what are the goals of putting this together?

Bo Gamble: Thanks Gordon. I'll tell you, as you said I've been in health care, with COA, almost 11 years now and been in cancer care for about 25. And over the years we have seen many programs come and go. Some of them did well. Some of them not so much. I'll tell you, Gordon, I'm really, really excited about what this program represents and why. And I'll kind of get into the why in just a minute.

There's a few reasons why I'm excited about it. One is this is COA and ASCO working together. And that's part of the message is like, "Okay, we're two fairly well-known organizations." ASCO is worldwide. We're more just for North America, United States, but we are working together. And the reason we're working together is because this really makes sense.

And part of the message that we're trying to deliver for those cancer care teams, and we'll get into other stakeholders in just a minute, is this really makes sense. And this is a good roadmap for you to follow if you're trying to really perform quality cancer care. That's kind of, in a nutshell, as far as one of the goals.

The other part of this is, good gracious Gordon, you followed us for a long time. I guess it was about, oh, our first payer summits. There was maybe 3 payer models in the country. There was the Aetna's you knew, and United Healthcare and Cigna was trying to do something. And John Sprandio started all with like, "Hey, I got this cool dashboard. I'm trying to measure how well my team's doing." We had 3 models. Well, about two years ago, actually September of 2020, we counted 35 models that we knew of, only that we knew of.

But if I had to guess today, there's probably some sort of value-based arrangement in cancer care going on in every state, probably. Probably in some cases in more than one. Good gracious, 2 years ago we counted, there was 7 in several different states.

Gordon Kuntz: Wow.

Bo Gamble: And that's exciting because I think there's an awakening that people are beginning to understand like, "Oh, there is a difference." For a long time you go to Doctor A and you get a treatment and you go to Doctor B get a different treatment. They're going to be paid exactly the same amount of money. One's right. One's wrong. One did well, one did not. You felt better in one case, and in one case you did not. They're going to get paid the same. But I think there's now been an awakening around the country, like "This doesn't really make sense. I'm paying my team to do something that may not work or may not work."

Thus, have been all these different models that happened. The sad part about all different models, and you look at any payer model itself, there's 3 main components. There's the care delivery, there's the care criteria which this model will be based, and then there are sort of the payment piece meaning, "Okay, I'm going to change the way payment's been done in the past, try to do it based off something that was results-oriented," whatever that means. And then oftentimes the glue is the measures. The glue would measure how well they're delivering the care. And then the measure be used in some sort of payment methodology.

Well in early discussions, and particularly we looked at the oncology care model that CMI came out with, we said, "No, no, no, no, no, this is not the right model. You need to change how you're doing this. You need different payment model." We tried to do the same thing with Aetna, United, whatever, and we wasted our time and our energy and our credibility.

What we have determined, though, is that of all models out there, the understanding and the definition and the criteria for the care should be the same across all models. And in all these models you had payers saying, "Oh, here's what I think good cancer care is." And you had another payer saying, "This is something totally different." They didn't always agree. They had different measures, different criteria.

The purpose of this model is to say is, "Okay," the cancer care community came together. By the way, hospitals, universities, community, patients, patient groups, even some GPOs along the way, says, "We think this is equal to good criteria, good standards, good detail standards for the cancer care journey from A to Z."

And that's what we're promoting. We're not promoting it as a payment model. We're not promoting as there are some measures as a baseline of measures saying, "Start with these measures. You can add to them." And that's been our message to not only care teams, but also to payers. And now the interest is incredibly high for employers and employer coalitions. They're paying the bill for the healthcare, like it or not. And they're saying, "This doesn't make sense. I need to know what I'm paying for and making sure my employees and my patients are being taken care of. And I don't know." So we're trying to define it as, this is the care model, defined by oncologists, use this. We can help you with other parts, but you need to use this piece.

Gordon Kuntz: Got it. So I was involved with Oncology Medical Home back when John Sprandio had kind of first come out with his starting in 2011.

Bo Gamble: I remember that.

Gordon Kuntz: Yeah. And NCQA had an oncology medical home certification process then. They stopped offering that a few years later. How is this different?

Bo Gamble: Well, I'm going to actually add to that piece that they had that offering. And actually, I think Dr Sprandio was the first oncologist to be recognized as an oncology patient center medical home. Funny little story, Paul said Dr. Sprandio visited with him several times, congratulate him. I was filling my notepad, taking all kinds of notes. We went to NWQA and says, "Wow, this is great. What about all this other oncologists?" And they said, "Hm, sorry, not yet." So then we developed our own version and I thought about oncology at home. That's when we brought payers together and GPOs and practices. And that was sort of a different model, that happened about seven, eight years ago with the Commission On Cancer through the American College of Surgeons, I thought went well. We had 10 pilots. They did really well. And then it sat on the shelf for three years. That's a different discussion.

But with the NCQA, that program, there's two distinctions. One is, it seems to be very policy-oriented, meaning, "Tell us how you're doing it. Upload your policy. All looks good. We'll give you your certificate." The other piece of that, and this I think really makes this program different, is there will be ongoing validation with the New Oncology Medical Home program. In the other one you had your certificate, three years, pay your money up for renewal, put in the lobby wall, put in the paper, whatever, good job, congratulations.

And this program, there is criteria that practices will need to meet every quarter for as long as that program exists. And while they're doing that, the bar is hopefully moving higher and higher because they're setting the standard for everybody to follow. One of the little tricks we learned as you know, there's a lot of competition sometimes in the provider network. And if they think so and so is doing better than they are, then they're going to work really hard to say, "Hey, I think I can do better, because I've got the better team." And we want to nurture that competition to be very transparent about promoting the quality there in a measurable kind way that can also communicated.

Gordon Kuntz: Little healthy competition goes a long way, doesn't it?

Bo Gamble: Yes, it does.

Gordon Kuntz: Excellent. So you've been visiting practices to review them against the standards. How many have you reviewed?

Bo Gamble: There's 12 different teams in the pilot. Seven of those are community-based, two or three are hospitals, I think there's two universities. It's been a wide range. And by the way, as we're developing this program, what about these other huge university-based centers? They need to have the same standards as well. I've been to six of those. Rhonda Bowman with ASCO, she's been to all 12. Kim Wooster sort of works with COA and ASCO. She's been to the other six. And it's been really good. And by the way, this was not a visit. "Hey, did they do it or did they not?" These were day long meetings, in some cases for bigger groups it took two days, where we talked through all of the domains, of which there were seven, and then the standards associated one says, "Okay, where are you at? How you doing? Let's talk about it."

And it was a time of encouragement and support and just talking about options, where they're struggling, where they're not, eventually maybe connecting them to some of the peers that are doing it well. Really encouraging through the process to say, "Okay, and at the end, it says, "Hey, you look good here, work on these pieces. Look at this." We pointed to some resources, gave them some ideas, whatever, and we're staying in touch with them, the whole group formally every month. Individually, also every month or so with one on one personal conversations, "How are you doing? What's going on? Let's talk about it."

Gordon Kuntz: So those monthly meetings, are they able to collaborate and kind of learn from each other?

Bo Gamble: Absolutely. In fact, another thing we learned, and shucks you know this too, things seem to work better when you've got a peer encouraging a colleague on something they're doing. If COA was saying up there, "Hey, this is COA. You need to be doing da, da, da," or ASCO saying, "You need to be doing..." They're like, "Hm, no thank you."  But when we can spotlight the champions, a certain area and they're sharing openly transparency with data and information, tips, tricks, whatever they've used in that area,, and by the way, it's in a Zoom call. Everybody's visual. They have lots of questions. That monthly call is in addition to sort of a open blog posting that the whole network can share between each other. So a question comes up in between times, they can comment on it. And that's another communication vehicle.

This past week, we had someone share the importance of patient advocacy and how this program is important to the patient and really understanding actually what to look for in quality cancer care. As you know, patients don't always know. They may say, "Hey, I love my doctor." And that's the biggest draw. They don't know why they love their doctor. "Oh, they're really friendly or they look good," or whatever. So we're trying to help them take that to the next steps saying, "Here's some things you need to look for in your care delivery system, whoever your care team is. And if you're not getting those, you need to ask for them to drive that quality along the way."

Gordon Kuntz: Yeah, that's always what have been one of the challenges I've felt with patient satisfaction indices in cancer care, because it's hard for a survivor of cancer to really be critical about the parking situation at their doctor since he just saved their lives. Right? And so I know you've headed up a lot of those initiatives, but it's great to see this on the front end with helping to educate, not just current patients, but prospective patients about what to look for. I think that's a real opportunity right there.

Bo Gamble: Yep, exactly. And that's our first domain by the way, and that is patient engagement. And the education starts there. Believe it or not, some teams struggle with that education. And it actually is two ways. It's a very comprehensive discussion with the patient early on. "Here's what you can expect from your care team." And then also patient, "Here's what we expect from you. We've got to work together to help you in your journey." And sometimes folks are, and we call it, they're in oncology medical home. They go, "Well, we're doing that, but that's not what we're calling it." I'm like, "Well then try calling it the oncology medical home. Otherwise, how are you distinguishing your care from somebody else's care? Let's put a label on what you're doing and then work towards making sure those standards exist." That way every patient everywhere, when they go to the barber shop, they wherever. "Oh yeah. I'm part of oncology medical homes. I'm getting great care. Here's why." And it's on label to it or whatever you want to call it. But you're defining that criteria for people out there

Gordon Kuntz: That makes total sense. That makes total sense. So a lot of these practices I'm guessing might have had some exposure to oncology medical home over the past X number of years. Don't have to name names. We don't want spill any dirt on anybody, but what are you finding? Is everybody doing everything just right?

Bo Gamble: No. Well, it's interesting, but I'm glad though, that not everybody's doing exactly right.

Gordon Kuntz: You wouldn't make a very good politician, Bo. You got to learn to-

Bo Gamble: Oh thank you. They wouldn't like me because I may be too truthful. We might have fun, but I might be too truthful. But I like the fact that, good gracious, they have to complete their submission for requirements at the end of April. So we'll start seeing, "All right, who really made it? Who worked and who didn't?" But I can tell you as of 30 days ago, nobody was ready, but that's okay. And I mentioned there's seven domains. There's 18 standards within those domains. If you do not count chemotherapy safety, that is the seventh domain and that includes their own standards. But Gordon, it was all over the map, where some teams were doing really good in some areas, some teams were struggling. And there's three areas in particular, I think the failure is universal. One is, and you'll get a kick out of this, probably you're talking about pathways all the time, and that is clinical pathways.

And you ask anyone, "Yes, we do clinical pathways." And we're saying, "Okay, how well are you doing clinical pathways? And by the way, are you measuring compliance by physician? And are you communicating compliance by physician for your major diseases on a monthly basis?" And they go, "Oh, maybe I'm not." And that is part of that program. It's part of that criteria. And some have done that well, some have not within that area. And as there is a boatload of pathway programs out there. Let me say a word here too. I'm just honored and pleased to be working with ASCO in this program, working with Rhonda Bowman, Steve [inaudible 00:17:13], Walter Burch and Veronica Gorman. That's my main contacts. John Cox is another one, Eric Martin and [inaudible 00:17:21]. And we're all working together and I'll tell you, I've really thoroughly enjoyed it.

We're very complimentary in our discussions, not only with care teams, but also we talk to other stakeholders when we get to that point. So pathways is a big item. I lost my point. Of all the pathway programs we have defined for. I'm not going to define them on the call today, but there are four specific pathway programs that we find acceptable. If they opt to use something other than those four, then they have to go through a list of criteria that says, "Did you do this, this, this, and this?" And by the way, there's a value component in there. There's got to be an update process, a vetting process, whatever. We do not want pathways to be confused with payer formularies. And that often is the case. So pathways, some have implemented it fully, doing well. Some are struggling with the corporate implementation, particularly as they grow. You pick up a new satellite and they got to teach them how to do things when they're there.

So the pathways is one. The second one is, and this is interesting, and you've seen a lot of discussion on that and that is, we call it equitable and team-based care. What does that mean, Gordon? That's a great question. Every one of the 12 pilots defines it differently. The intent of the definition, the standard is look beyond that visit, look beyond that tumor, look at your entire community. What's happening out there? Are you reaching all of the patients that you may not be reaching that you think you are, whether it be race, whether it be ethnicity or whether it be zip code or whatever it is. Are you reaching out to them? How do you know? And show me how you prove that you were. And then what are you doing to help them? A classic example, not related to this program, but it's a lesson learned along the way.

One of our friends down in New Mexico, she has a really tremendous cancer care team, and they started doing mobile breast cancer screenings in their area. And they were so excited. A beautiful van, the wheels were polished. It looked great, nice details, whatever. And it was not working out well. And they go, "Why not?" Well, one of the reasons is, and they asked them, "I don't understand why we're not seeing more people." And then come to find out, potential patients were saying, "Do not go in that van because if you come out, you'll have breast cancer."

Gordon Kuntz: Oh my gosh. Ugh.

Bo Gamble: But it speaks to where patients were. Oh my goodness. What a great example that could be, is understanding that notion. And now we're seeing all kinds of initiatives. ASCO's got one. We've got one. Trying to really define health equity, measurable, social determinants of health and how you're going after it, promoting it. And then we're saying, "Okay," to your local employer or your local employer, I'm reaching out to everybody in my community. I'm a really good steward for that effect. I'm trying to help our entire population, not just if they've been diagnosed. But that one's also kind of maturing even as we're talking. The third one and I think I'm kind of glad they're struggling on it. There's another standard or another domain for quality improvement.

And you mentioned earlier, patient satisfaction, big fan of patient satisfaction. And if you ask, "Oh yes, we're doing a patient satisfaction." What are you doing with it? And that's some of that criteria is like, "Okay, where'd you score well? Where'd you score not so well? Do you see a distinction by physician or care team? Do you see a distinction by location? And what are you doing to address it." Wait some time. "Did what you do to address it, did it fix it?" And that needs to be an ongoing basis. Not only that, but also pick a quality improvement project. Dr. John Cox said it best, if you look at the entire oncology medical homes, it's really, the entire program is a quality improvement project, because here's the standards. Do not rest if you get there because we're going to keep watching you.

By the way, pathway compliance is another one. Are you doing that? Are you improving your compliance rate? Or not only your steerage rate, but your compliance rate on your pathway stuff? So those three areas are probably the bigger ones. I'm kind of excited about the quality improvement because it's getting people in that mindset of like, "Did I do it or did I not?" And then measure it. Don't just give me lip service that you're doing it. Prove to me that you are. And then we'll carry the flag for you wherever you're going to promote those good things that you're doing.

Gordon Kuntz: Yeah. Great. So you used to run a practice. So you know what implementing a program like this from an operational standpoint would be like for these practices. How involved is it, whether it's the community practices or the hospital, to comply with these standards? Because they sound rigorous, which is great. Obviously require a certain degree of monitoring and communication, which is sometimes hard, but how hard is it for them to really do what you're asking them to do?

Bo Gamble: Well, the bad news is, I guess or good news is, we're 12 for 12. Everyone says it's hard work. I'm like, "Well, good. We don't want it to be easy. It's hard work."

Gordon Kuntz: That's how you know it's working, right?

Bo Gamble: However, some of them are really taking sort of a good view of it. And that is like, "Let's stop. Let's breathe. Let's think about it." Gordon, I think the hardest challenge is getting people to the mindset of measuring how well they're doing. Once they get that mindset in place, then working it out seems to work. It's like, you find your goal, where you want to be, and then you figure out how to get there. Some it's been harder. Sometimes some of the big organizations, they're just as political as they can be. And are they supported? And whatever. COVID's hit some hard because of staff shortages. For example, there's a criteria for financial assistance, and many teams, they've lost their financial counselor, guider.

Now they're trying to fill that gap, because we're saying, "Okay, show us how well you have provided financial assistance for your patient population." And we're converting that by physician to normalize the data. So we're pushing them to do that data. It is hard work. Now, but with all that sand though, some feedback that we received, and some of these were stellar organization, they've been through JCO. They've been through URAC. They've been through COA for lab inspections, whatever. Unsolicited they said, "This by far is the most meaningful program they've ever been in." I'm like, "Yes."

We want it to be meaningful, and if it's not meaningful, we shouldn't do it. But they're saying it's meaningful because it's changing their culture, it's changing their mindset. And they said, "You would not believe how much pride is now being injected to their staff to be part of something that has great meaning." And they can demonstrate how well they're doing in these areas. I remain very optimistic to see that. Hey, I'm glad they're somewhat struggling. We don't want it to be topped out on anything. You got to work for a little bit of it.

Gordon Kuntz: I mean, it's interesting because what you're really talking about is a culture change. Right? Not just the culture of quality, the culture of improvement, but the sentiment from the physicians, nurses, staff have spent the last two years, it didn't start then by the way, completely burned out. Right? I mean, that started way before COVID. It's just gotten a lot worse. Seeing improvements, I think is one of the things that they haven't been able to do in the last couple of years. They've been treading water, running in place, and actually being able to see some movement and improve quality for patients. That's what drives everybody I know in oncology. So I think that is a marvelous byproduct of this.

Bo Gamble: Well said. And you're improving. "Okay, where are you improving? Where are you improving? Help me understand. And by the way, are you communicating what you're doing to your payers, your employers? Are you communicating to [inaudible 00:26:36]? Guys, this is exciting. We are so honored to offer this type of care in your community. Here you go." And you're exactly right. Kind of a little piece of history here. As we were preparing for our site visits, our initial visit to say here's where we are. We struggled on the words because we're saying, "Okay, here's the criteria. We're ready to talk about it." And people were struggling. They were working on policies. And we had to says, "No, give me your proof. Give me the proof of how you're compiling with the standard, not that you have a beautiful policy and it's on 20 pound paper and it's luxury font, whatever, and you can read it. I want to know, prove to me what you're doing here. Policies one, you certainly can guide it. But how well are you following your own policies for this criteria?"

Gordon Kuntz: It's interesting because I've never met an oncologist who said they were among the worst oncologists in the community. They all are going to tell you they're they're in the top 10%, and everybody can claim that. But having something measurable like this, where you're asking them to, again, not claim it, but demonstrate it, I think is a key differentiator with this. That's really awesome.

Bo Gamble: Gordon, I may have shared this story before, but somewhat related to patient satisfaction. Shame on CMI and their ocnology care model, because they never got this. They had a patient satisfaction survey. Sadly it was a year late. It was not available by physician. And as I had been told many times as regarding patient satisfaction if you plop down satisfaction scores on the board room table with your physician's present in your weak in an area, every physician that room's going to be looking at each other saying, "You're not talking about me. You're talking about somebody else." So it's got to be by physician, every aspect of it, whether it be pathway compliance, patient satisfaction, anything, even financial assistance. The provider team can help with making sure those patients get that. Give that feedback. And if you give feedback to them like, "Hey, just letting you know, you're the low man man. You're the low woman. What are you going to do? Game on." Boy, they're on it then. But they have to know, and they can't change their behavior unless they know the difference.

Gordon Kuntz: Unless they know. Yeah. You can't change what you can't measure. So you've been involved in value-based care for a long time. You mentioned earlier, this was not a payment model, but really payment reform, a payment model is going to need to come along if payers are going to be involved. How do you see that fitting in here? And do you anticipate there's some sort of reimbursement by payers, by CMS, whoever it might be, that would help offset what I'm guessing are some costs associated with putting a program like this in place and keeping it up?

Bo Gamble: Very valid question. And I'm going to do a little adjustment here. Instead of calling it payment, I'm going to call it recognition, and it could come in different forms or fashion. Actually, I'm going to touch on another comment you made with regard to this model and hopefully the future oncology model from Medicare. We are promoting to them, "Please, please, please use this as your clinical base. Please." The prior model had the 13 care points of the internal medicine. Some worked, some did work. Some of it was a struggle, but we're trying to promote it as a universal standard. And there's many ways that we're trying to get there. One is talking to payers. "Please don't customize your own care model expectations. Use this instead." But then we can get into say, "Okay, what about if they are 90% compliant on pathways. Here are the four pathway programs."

Can you not exempt them from prior authorization requirements or recognition? Can you give to them a bonus if they have a very comprehensive, detailed, heartfelt end of life discussions with their patients? And by the way, why don't you remove the patient out of pocket and co-insurance? That conversation is so very important. So it could be payment like, "Okay, by top tier on the scores, whatever you could get your little bonus like you did in the OCM," but it can go so much further than that. Some things that we're trying to promote when we talk to employer coalitions, I'm like, "The door is now open for you, Mr. Employer, with education from your coalition. Why don't you start modifying your health insurance benefits to things that drive the patient to do the right thing? Why don't you make it harder for them to do the wrong thing? Like our friend [inaudible 00:31:39] does in the [inaudible 00:31:41] program? Call it [inaudible 00:31:43], call it something else.

But changing insurance benefits to promote the right thing happening, with biosimilars versus branded. I mean, there's a whole mixture of things that people could zero in on and it could be steerage. "Okay, you're coming here. I'm going to make your deductible. Co-insurance less if you go here versus somewhere else. By the way, if you're achieving, you can maintain the certification, I'll give you a bonus every year, every month for your patients." In other words, recognize distinguishable, measurable, high quality care to keep these programs going and to reinforce we need everybody to do that. Not just onesies and twosies, heres and there. So I think we're in a season where healthcare teams need to justify what they're doing. And if they're doing great, by golly, let's just put the spotlight on them and say, "These are examples of things being done really, really well," and reward them, recognize them, help them. Don't restrict it.

Gordon Kuntz: Yeah. It sounds like you're having conversations with payers and employers. Have some shown interest in kind of adopting this as you've talked about?

Bo Gamble: Absolutely. Good gracious, we've got one payer committed to give us data. By the way, on the database, we're trying to marry clinical data and billing data. Wow, we really got something then. One payer's committed, but they've had some transitions and we're trying to get to the database. We're in discussions with about four others. And Gordon I really think if we can get one or two signed up and they're starting to do something, momentum creates more momentum, the better. We've had a payer come to the table in the last 30 days because they're hearing about it. And then in this case, the payer, national payer, openly being very transparent says, "Yes, this is good because we've always been focused on the payment. We've not focused on the care." I said, "We got a solution for you. Here's the care. Why don't you put the care and then you can do the payment on top of it?"

That's good. However, as sometimes it's hard to move with the payer side, because they're in cahoots with the PBMs, and often times they move in the opposite direction. So we're now talking to employer coalitions. We've talked to two regional ones. We've got a national one scheduled for tomorrow, trying to get it in front of them saying, "Hey guys, we're excited about this. This is why. Are you interested to know..." Here's how we're start that discussion. We present to them questions that employers may have regarding care for their employees. "How do I know if it's good? Where can I get good? What is good?" They're asking this, they're asking that, whatever. These are really valuable. And not only patients, providers ask the question. Payers ask the questions. Everybody's asking the same questions.

And we're trying to say, "This is a place to start. By the way, the programs can continue to mature and get better over time, but start here. And here's why." That's the first step in that conversation. Our next step, if we do it well, and that is to get in front of their membership, so employers, whether they're small, medium, or jumbo, local, whatever, chains, all kinds of things.

So they can see, "Oh, I need to be looking for these things. And by the way, I may get creative on my own benefits or on my own payment regarding my patients." Because if any employer, cancer care, although it's a big part of their spend, it's a minuscule part of their agenda. They've got so many other issues. So if we can make it easy for them to be in charge own destiny and to recognize quality and value along the way, we make it easier for them, the better off we'll be.

Gordon Kuntz: Yep. No, absolutely. Absolutely. So I know you're involved in a lot of conversations. You talked to a lot of folks. Any idea what CMI is thinking about regarding their next oncology program? Give me a scoop. Come on, Bo. Do you think it's going to involve this ASCO co-oncology medical home model?

Bo Gamble: I hope so. I hope so. I'll tell you why I hope so. But we introduced this program. Actually, we had a discussion with some key in leadership with CMS and CMI on the program and we were expressing how much we need reform. And you look at the evaluation reports they produced and it's like, "We've lost money. We're going to stop the program." But they made that decision way early before some of the evaluation reports came out. And we're trying to make a couple points.

One is, it's been incredibly transformative. Teams will tell you, every one of them, if they were committed, how important that program has been to the transformation of care. Secondly, in the argument we're trying to say, "Guys, you can't leave. You can't stop." Because if you look at the timeline, when CMI came out with their oncology care model, then everybody followed suit. Now, hindsight's 20/20, if they'd have been a little more sort of structural about, "Here's what you need to do," maybe we wouldn't have 35 models. Maybe we'd have had a narrow set of criteria. But we tried to emphasize to them, I says, "Guys, as long as I've been around, Medicare has been the leader. Like it or not, they had fee schedules. They had guidelines, coverage determinations, policies, communications. Everything was measured against how well Medicare did it."

Medicare's been a leader in reform in cancer care. Payment methodology was complicated. Measures were sometimes crazy. However, there was a start. I'm like, "Guys, we can't afford for you to stop. You got to keep going because we need a leader. And if we don't have a leader, everybody's going to flounder." That message seemed to resonate. And also in other discussions with some teams like, "This is what we're doing, this is why we're doing it." And they says, "Wow, wow, very good to know."

Now some other details going on, but I don't know if you saw yesterday, the preliminary role for the radiation model came out. However, there wasn't much to it other than the fact they said, "Oh, by the way, they slipped in the law that says they can't do anything in the radiation model until January 2023. So we'll plan to do something in the future. That's going to be January 2023." Also I think it was last 10 days, I heard from three OCM participants that said, "We hear you loud and clear. You want the model to continue. Stay tuned. We will have some news for you soon."

Gordon Kuntz: Good.

Bo Gamble: Now, soon in government time might be five years, next week. I don't know. But they were very somewhat aggressive or very positive and they were very direct in their wording. It only went to them. There was no press release. There was no, "By the way Bo, here's what was going on." It was good. We'll see.

Gordon Kuntz: Well, good. Hopefully you convinced them, Bo.

Bo Gamble: If I had to guess, I'd say January of 2023. Throw out a guess.

Gordon Kuntz: There you go. So is anything else that you think everybody would want to know about the oncology medical home?

Bo Gamble: Well, I think the oncology medical home is but a part of the full transformation of accountability in healthcare. As we go down the path and we start seeing some really misalignment of incentives, and we know what they are, there's differences in payer site. There's differences in programs that are like, "This is not right." So this awakening is not only to help us make note of issues that are out there. But I think it's also saying, "No, I want to know what I'm paying for. I want the best outcomes for my patients so that they have good quality of life, et cetera." So we're beginning to quantify good, better, best, all the way around. Not only in the care delivery, in measures, in all aspects of healthcare. So there's been this awakening and I hope instead of calling it a reform, I'm calling it a reformation. Because we're really trying to fix a lot of things that were wrong in healthcare, have been as long as healthcare's been around.

And we're finally getting to a spot that says, "Oh, let's do it." Now it's slow. Good gracious. But if we can get some real quick victories on some policy issues that would help. And if we can get the more message. In fact, I talked to Rhonda three or four times a day with ASCO. Our main focus now is to get the message out, oncology medical homes, to as many people as possible. And they go, "Well what about the 12?" We're like, "The 12 is one thing. However, the standards are out there available to anybody. Grab them, start on it, work on it. We'll help to keep the program continued." But they shouldn't wait for that because there's going to be work to do. Go ahead and do it. Employers, you can start looking for these things. Payers, you can start doing these things, whatever. Let's start moving in that direction. And by the way, if you see if there's any point in that journey that, in the cancer care journey, that's not addressed that needs to be, by golly, please tell us. We need to include that in the program. So that's exciting.

Gordon Kuntz: Excellent.

Bo Gamble: I hope we see things change before I leave this earth, Gordon.

Gordon Kuntz: Well, I think you might have a couple of good years left. A couple of days that you can work on it.

Bo Gamble: I don't know. I don't know.

Gordon Kuntz: One never knows. Well, thank you Bo. That wraps up this episode of Oncology Innovations. And Bo thank you so much for joining us today.

Bo Gamble: Thank you for having me.

Gordon Kuntz: And as always, a big thank you to the Journal of Clinical Pathways for producing this episode.

Bo Gamble: Thank you guys.

Gordon Kuntz: Thank you. Please. Download, rate, and review and subscribe to the podcast. For more episodes, you can visit www.journalofclinicalpathways.com, or you can find us on Apple Podcasts, Google podcasts, and Spotify. Also be sure to share oncology innovations with a friend or colleague. Let me know your reactions to episodes, questions, and recommended topics for future episodes. You can find me on LinkedIn or you can send me an email to gordon@gordonkunts.com to request specific topics and guests. See you next time. Thank you.