Samyukta Mullangi: How Biden’s Cancer Moonshot and CMMI’s Enhancing Oncology Model can be the forcing functions to promote value-based care in oncology?

Samyukta Mullangi, Medical Director at Thyme Care, recently posted on LinkedIn:

“I shared some thoughts about how Biden’s Cancer Moonshot and CMMI’s Enhancing Oncology Model can be the forcing functions to promote value-based care in oncology with MedCity News. A high-level summary:

a) On a per-patient cost basis, cancer is the most expensive segment for insurers, who often respond with variations of utilization management programs – pathways, formulary restrictions, expanded prior authorizations, etc. These frustrate physicians and patients and may lead to patient harm.
b) A different and possibly more sustainable/successful approach would be to encourage the shift to value-based payment models, in which physicians and practices are paid on the basis of the results they deliver – such as quality, equity, and cost of care.
c) That being said, value-based care represents a paradigm shift for providers, who will need more sophisticated technology to generate population-level actionable insights, new staffing models and scope of work, data analytics expertise to process stacks of new data – claims, clinical, patient-reported, other – for both interpretation and reporting, and a capital reserve or insurance to weather downside risk.

While challenging, these efforts are likely worth it. Per their last strategic refresh, CMS has indicated that it aims to have all Medicare/Medicaid beneficiaries enrolled in such accountable care programs by 2030. This suggests that while current models (such as OCM/EOM) are voluntary now, this may not always be the case.”

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Source: Samyukta Mullangi/LinkedIn