how cancer programs are responding to covid-19 and

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Presented by Service Line Strategy Advisor How cancer programs are responding to COVID-19 and planning for future market trends

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Presented by

Service Line Strategy Advisor

How cancer programs are responding to COVID-19 and planning for future market trends

© 2020 Advisory Board • All rights reserved • advisory.com

‹#›

Road mapRoad map2

How cancer programs are responding to COVID-19 1

2 Growth outlook for oncology services

3 Key trends and imperatives for the oncology service line

© 2020 Advisory Board • All rights reserved • advisory.com

3

Tracking the spread

Jan 11, 2020

Chinese government

reports first death

due to new virus that

began spreading in

late 2019

Jan 13, 2020

The first case

outside of China

is confirmed in

Thailand

Jan 30, 2020

WHO declares global

emergency

Cases reported in Japan,

South Korea, India, the

Philippines

Jan 31, 2020

Russia, Spain, Sweden,

UK confirm first cases

9,800 reported cases, 213

deaths worldwide

Feb 14-21, 2020

First cases reported

in Egypt, Iran, Israel

as the virus spreads

to the Middle East

Feb 1, 2020

Cases reported in

Australia, Canada,

Germany, Singapore,

the UAE, the US,

Vietnam

Feb 28, 2020

Nigeria, Lithuania, Wales

report first cases

The US reports its first death,

near Seattle

Feb 24-27

Kuwait, Bahrain, Iraq,

Afghanistan, Oman, Brazil,

Norway, Romania, Greece,

Georgia, Pakistan, North

Macedonia report cases

Mar 24, 2020

>392,000

reported cases,

>17,000 deaths

worldwide

Two months after the first reported death, COVID-19 circled the globe

Advisory Board interviews and analysis.

Source: “A Timeline of the Coronavirus,” The New York Times, March 4th, 2020.

© 2020 Advisory Board • All rights reserved • advisory.com

4

Coronavirus cases in the United States

96 million cases

4.8 million hospitalizations

480,000 deaths

Estimate of possible effects

33,404 cases

54 jurisdictions reporting cases

400 deaths

Current COVID-19 cases

6-50 reported cases

51-100 reported cases

101-500 reported cases

Current as of March 23, 2020

Advisory Board interviews and analysis.

Source: “Coronavirus Disease 2019 (COVID-19) in the US,” CDC,

March 11, 2020. “One slide in a leaked presentation for US hospitals

reveals that they’re preparing for millions of hospitalizations as the

outbreak unfolds,” Business Insider, February 27th, 2020.

501-1,000 reported cases

1,001-5,000 reported cases

5,001 or more reported cases

© 2020 Advisory Board • All rights reserved • advisory.com

5

Source: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Protecting cancer patients critically important

Advisory Board interviews and analysis.

Sample strategies to reduce patient and staff risk

• Cancelling in-person events, activities,

meetings

• Encouraging work from home when

possible

• Restricting employee personal travel

• Planning for impending supply

shortages

• Rescheduling non-essential visits

• Fast-tracking injections

• Separating lab and infusion visits

• Encouraging appointments during

extended hours

• Minimizing patient “touches”

• Screening patients before visits

• Implementing rapid triage protocols for

suspected cases

• Restricting entry and number of visitors

• Offering onsite “drive-thru” testing and

testing tents

• Deploying telehealth

CMS broadens access to telehealth for Medicare beneficiaries

• Effective March 6, 2020 for the duration of this emergency, CMS

will reimburse for telehealth visits, virtual check-ins, and e-visits

• Includes all beneficiaries in all settings in all parts of the country

• Allows use of everyday communication technology, such as

FaceTime, Skype

REGISTER NOW

Join our upcoming webinar on How COVID-

19 is transforming telehealth—now and in

the future on Thursday, March 26th at 3pm ET

© 2020 Advisory Board • All rights reserved • advisory.com

6

Make sure patients can easily find the info they need

Advisory Board interviews and analysis.

Read our full take on the

Oncology Rounds, as

well as links to related

ASCO and NCCN

resources

Creating dedicated cancer

program webpages

Sharing in-the-moment updates

through social media

Making eye-catching

in-person signage

• Use webpage to house all

material pertaining to COVID-19,

including updated cancer

program policies and patient

information

• Check out a few examples:

• Seattle Cancer Care

Alliance

• Roswell Park

• MD Anderson

• Winship Cancer Institute

• The University of Kansas

Cancer Center

• GW Cancer Center

• Share constantly-evolving

information and updates through

Facebook, Twitter, and other

social media outlets

• Create short videos for patients

on YouTube

• Create colorful, easy-to-

understand signage in the

cancer center

• Ensure all employees are

equipped to answer patients’

questions and explain changes

in policy as appropriate

• Ensure consistency with website,

email, and hotline information

© 2020 Advisory Board • All rights reserved • advisory.com

7

Establish clear communication channels for staff

Communication challenges during acute work pressure

Give staff a consistent

source of truth

• Send messages

from the same

person/email

• Send them at a

consistent cadence

• Link to centralized

page of resources

on intranet

Increased stress and

emotional pressure on staff

responding to outbreak

Potential for misinformation

from external communication

channels

Difficult to convene

frontline staff to deliver

messages

Advisory Board interviews and analysis.

Minimize non-

essential emails

• Centralize the

decision to send

org-wide emails

that aren’t about

COID-19

• Consolidate any

essential non-

COVID-19

messages

Field and respond

to rumors

• Set up a channel to

field rumors, such as:

– Dedicated

anonymous phone

line

– “What’s the buzz”

council with frontline

staff representatives

• Regularly publish

FAQs

Share your gratitude

personally and often

• Acknowledge the

challenges an uncertainty

staff are navigating

• Recognize the sacrifices

team members are

making

• Emphasize staff health

and safety as much as

patient/family health and

safety

Make yourself

virtually accessible

• Establish regular

virtual office hours

• Hold virtual town

halls

© 2020 Advisory Board • All rights reserved • advisory.com

8

How to respond today and how to prepare for the long-term impact

Your top resources for COVID-19 readiness

Advisory Board interviews and analysis.

To access the top COVID-19 resources,

visit advisory.com/covid-19

CDC's health care personnel

preparedness checklist

CDC's hospital preparedness checklist

CDC's COVID-19 case tracker

CDC’s infection prevention and control

recommendations for COVID-19 patients

Links to external resources, such as:

Rebuild the Foundation for a

Resilient Workforce

Anatomy of an Outbreak: COVID-19 and

the U.S. Health Care Delivery System

Managing clinical capacity

Coronavirus scenario planning: 12 situations

hospital leaders should prepare for

Advisory Board resources, such as:

© 2020 Advisory Board • All rights reserved • advisory.com

‹#›

Road mapRoad map9

How cancer programs are responding to COVID-19 1

2 Growth outlook for oncology services

3 Key trends and imperatives for the oncology service line

© 2020 Advisory Board • All rights reserved • advisory.com

10

Lung cancer projected to have highest incidence increase

1. .

Cancer incidence five-year growth projections, by tumor site

Service Line Strategy Advisor research and analysis.

Increase in incidence expected for all cancer types

Source: Advisory Board’s Cancer Incidence Estimator.

13%

11% 11% 11%10%

9%8%

7% 7%

4%

15%

Hematological GI Urologic Melanomas of

the skin

Lung and

bronchus

National estimates, 2018-2023

10% Combined five-year growth

Head and

neck

Brain and

other nervous

system

Breast Gynecologic Thyroid Other

© 2020 Advisory Board • All rights reserved • advisory.com

11

IP medical oncology expected to decrease

1. Includes biopsies from service lines of dermatology, ENT, gastroenterology, general surgery,

gynecology, orthopedics, thoracic surgery, and urology.

2. Positron emission tomography.

3. Inpatient and outpatient surgery service utilization broken out by skin, urological, GI, gynecological,

prostate, colorectal, hematological, head and neck, thoracic, breast, neurological, and other tumor sites.

Outpatient, inpatient oncology service volume growth

Service Line Strategy Advisor research and analysis.

OP service volumes also expected to increase, led by surgery

Source: Advisory Board’s Oncology Market Estimator.

22%

14%

10%

3% 3%

9%

2%

27%

3%

-4%

National estimates, 2018-2023

11% Combined five-year growth

Inpatient

Outpatient

OP radiation

therapy

OP

chemotherapy

IP medical

oncology

Overall IP

surgery3

Overall OP

surgery3

Biopsy1 Colonoscopy MammographyBreast

ultrasound

PET2

Screening/diagnostics

© 2020 Advisory Board • All rights reserved • advisory.com

12

Expect decline in IP surgeries for most tumor sites

Outpatient, inpatient cancer surgery volume growth, by tumor site

Service Line Strategy Advisor research and analysis.

Growth expected across the board for OP surgeries

Source: Advisory Board’s Oncology Market Estimator..

31% 29%

24% 23%

15%

11% 11% 10% 9%

4%2%

9%

-10% -11%

-4%

11%

-8% -7%

-2%

7%

13%

Urological

(non-prostate)GI (non-

colorectal)

Gynecological ProstateSkin

National estimates, 2018-2023

26% Combined five-year growth

Colorectal Hematological Head and

neck

Thoracic Breast

Outpatient

Inpatient

Neurological1

1. There is no growth projection for outpatient neurological cancer surgery volumes because

neurological cancer surgeries are performed in the inpatient setting, so there are no baseline

outpatient neurological cancer surgery volumes from which growth can be projected.

© 2020 Advisory Board • All rights reserved • advisory.com

13

Source: Advisory Board’s Market Scenario Planner..

Technology top detractor from OP utilization, care management from IP utilization

Aging population is biggest growth driver across care settings

Service Line Strategy Advisor research and analysis.

Outpatient1, inpatient2 oncology growth drivers

Outpatient

National estimates, 2018-2023

Inpatient

+3.5%+3.5%

+3.7%

-9.3%

-3.0%

-1.7%

-6.2%+0.0%

-2.9%+5.2%

+1.8%

+2.5%

+3.5%

+0.0% +0.0% +3.9%

1. Outpatient chemotherapy and radiation therapy.

2. Inpatient medical/hematology oncology and radiation oncology.

© 2020 Advisory Board • All rights reserved • advisory.com

‹#›

Road mapRoad map14

How cancer programs are responding to COVID-19 1

2 Growth outlook for oncology services

3 Key trends and imperatives for the oncology service line

© 2020 Advisory Board • All rights reserved • advisory.com

15

Three trends impacting the oncology service line

Service Line Strategy Advisor research and analysis.

Cancer care is becoming more complex as patient demographics shift and clinical innovations abound1

Payers’ efforts to control oncology spend directly threaten providers’ growth 3

2 Cancer patients are demanding a seat at the decision-making table

© 2020 Advisory Board • All rights reserved • advisory.com

16

Source: Jemal, A, et al, “The Cancer Atlas,” American Cancer Society, 3 (2019),

www.canceratlas.cancer.org .; “State Chronic Conditions Dashboard,” CMS, 2019. https://cms.gov/research-

statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/ccdashboard.

Caring for an older, more complex, and costly population

Oncology Roundtable interviews and analysis.

Percentage of Medicare cancer patients with comorbidities

2017

Beneficiaries with 4

or more conditions

account for 75% of

total Medicare spend

Increasing comorbidities related

to aging population

• Most older adults diagnosed with

cancer present with at least one other

chronic condition

• Aging population of survivors

drives increasing rate of

cancer-related morbidity

• Screens for risk of comorbidities and

methods to mitigate their effects are

increasingly important

• Cancer patients with comorbidities

incur higher cancer treatment costs

7% 26% 30% 37%

Cancer only 1-2 comorbidities 3-4 comorbidities 5 or more comorbidities

Cancer treatment not only is complicated

by comorbidities, but also can cause them

Cardiotoxicity of chemotherapy is a major

concern and drives the rise of cross-

specialty care (i.e., cardio-oncology)

Trend 1: Cancer care is becoming more complex as patient demographics shift and clinical innovations abound

© 2020 Advisory Board • All rights reserved • advisory.com

17

Influx of new drugs adds to complexity of care

Oncology drugs for 17 different

indications launched in 2018

15

Cancer drugs currently in

late-stage development

> 700

Source: IQVIA, “Global Oncology Trends 2019,” 2019, Iqvia.com/-/media/iqvia/pdfs/institute-reports/global-oncology-trends-2019.pdf.

Of drugs in late-stage development:

• 450 are immunotherapies

• 98 are cell, gene, or nucleotide therapies

Over half of new therapies have orphan

drug indication, are delivered orally, or

include a predictive biomarker on their label

Service Line Strategy Advisor research and analysis.

Drug launches in 2018

Drugs in development

Oncology drugs for 89 different

indications across 23 cancer types

launched between 2014-2018

57Expansion in pipelines of cancer drugs

in late-stage development in 2018

alone, and 63% expansion since 2013

19%Of late-stage R&D dedicated to

oncology by world’s 14 largest

pharmaceutical companies

1/3

Of drugs approved in

2018 were personalized

40%Of current clinical

trials use biomarkers

>1/3

© 2020 Advisory Board • All rights reserved • advisory.com

18

Plan to manage more complex patients and more complex treatment

Prepare your care team for increasing complexity of care

Service Line Strategy Advisor research and analysis.

Key imperative 1

Provide coordinated, multidisciplinary care

Grow cross-service line specialties (e.g., cardio-oncology, geriatric oncology)

Improve transitions back to primary care

Equip the care team to adopt treatment innovations

Include new expertise on the care team (e.g., molecular scientists, bioethicists, data managers)

Provide training and support to help physicians implement and stay up to date on clinical innovations

Provide comprehensive education and support to patients

Account for increased physician and nurse time needed to manage patients receiving complex therapies

Develop a principled approach to prioritize between investments in clinical innovations

© 2020 Advisory Board • All rights reserved • advisory.com

19

Consumers breaking traditional health behavior patterns

Patients becoming more influential decision-makers

Increasing access to

health care information

1

• Access to and use of the

Internet now nearly

ubiquitous

• More organizations

publishing health care cost

and quality data

• Growth in online

communities and availability

of patient reviews

Rising expectations

for service

2

• Patients gaining experience

with different-in-kind

providers (e.g., Walgreens,

MinuteClinic)

• Nature of patient-physician

relationship changing;

patients more skeptical and

questioning

Growing price

sensitivity

3

• Rising health care costs

• Patients shouldering larger

portion of health care costs

• Patients increasingly

including costs, in-network

coverage when selecting

providers

Oncology still referrals driven, but patients playing more active role

Trend 2: Cancer patients are demanding a seat at the decision-making table

Oncology Roundtable interviews and analysis.

© 2020 Advisory Board • All rights reserved • advisory.com

20

0.8

1.4

1.6

2.9

3.1

3.4

4.8

4.9

5.5

6.5

10.8

11.1

12.3

13.3

17.5

Source: 2019 Cancer Patient Experience Survey.

Clinical quality is king

Oncology Roundtable interviews and analysis.

Doctor who specializes in my particular cancer

Technology and treatment options

Clinical quality (e.g., survival rates)

In-network for my insurance

Accreditation (e.g., Commission on Cancer)

Patient support services

Costs I’m responsible for

Reputation (e.g. US News “top doctors” report)

When deciding where to go for care, which feature is most and least important to you?

n=1,201 cancer patients

Recommendation from my doctor

Recommendation from my family and friends

Location

Availability of appointments

Facility and amenities

Customer service

Availability of clinical trials

Mean utility scores

Did you know?

“Doctor who specializes in my particular cancer”

ranked as the most important factor in both our

2015 and 2019 surveys. In 2015, 43% of patient

ranked it #1. In 2019, that increased to 52%.

© 2020 Advisory Board • All rights reserved • advisory.com

21

The internet is a key source of information for patients

Cancer patients doing their research

Oncology Roundtable interviews and analysis.

3%

3%

3%

4%

4%

5%

7%

12%

15%

19%

23%

33%

34%

81%

Other

Community website, forum, or blog

Employee health navigation site

General ratings website

I did not consult any resources

Social media website

Medicare or other government website

Medical-focused ratings website

Major search engine

Cancer-specific website

Family, friends, or colleagues

My health insurance company

Cancer center, physician practice website

My doctor

Which of the following resources did you use when deciding where to go for your cancer care?

n=1,201 cancer patients

of cancer patients searched online

when deciding where to go for care

48%

average number of sites consulted

by patients searching online

2.1

Source: 2019 Cancer Patient Experience Survey.

© 2020 Advisory Board • All rights reserved • advisory.com

22

Patients will leave you if their expectations aren’t met

3%

4%

6%

7%

10%

13%

13%

17%

18%

20%

23%

28%

Why did you change cancer care providers?

n=127 cancer patients

I found a different doctor who specializes in my care

I wanted more/different treatment options

I found a higher quality program

I wanted a location that was closer to my home/work

They could not provide the treatment I needed

Friends or family recommended a different provider

I wanted better support services

I wanted better customer service

I wanted access to clinical trials

I wanted a nicer facility and better amenities

I couldn’t get appointments when I needed them

I wanted to spend less money on my care

DATA SPOTLIGHT

of cancer patients said they

changed care providers at

some point during their

treatment because they were

dissatisfied with their care

11%

Oncology Roundtable interviews and analysis.

Source: 2019 Cancer Patient Experience Survey.

© 2020 Advisory Board • All rights reserved • advisory.com

23

Convenience and coordination is of the utmost importance

Oncology Roundtable interviews and analysis.

Source: 2019 Cancer Patient Experience Survey.1.52.1

2.3

2.3

3.0

3.3

3.5

3.5

4.4

4.5

4.6

5.4

5.9

6.7

7.1

9.0

9.2

10.9

11.0

All of my care takes place in one building

Specialized symptom management

Multidisciplinary care clinics

Nurse phone line for help with symptoms

Survivor support services after finishing treatment

Patient education services

Help scheduling and coordinating my appointments

Support services for my family

Online portal to view test results, contact care team

Help with nutrition

Extended hours of operation

Complementary and alternative medicine

Access to genetic testing and counseling

Parking that is convenient and affordable

Free or discounted transportation

One point of contact to help me understand my care

Financial counseling

Social and mental health services during treatment

Religious and spiritual services

Which services would have been most valuable and least valuable to you?

Mean utility scores

n=1,201 cancer patients

© 2020 Advisory Board • All rights reserved • advisory.com

24

Cancer patients want to be involved in care decisions

Oncology Roundtable interviews and analysis.

Source: 2019 Cancer Patient Experience Survey.

3%

38%

50%

7%2%

I make the decisionswith little or no input

from my doctor

I make the decisionsafter seriously

considering my doctor'sopinion

My doctor and I makethe decisions together

My doctor makes thedecisions after

seriously consideringmy opinion

My doctor makes thedecisions with little or

no input from me

What is your preferred level of control when making decisions about your cancer treatment?

n=1,201 cancer patients

© 2020 Advisory Board • All rights reserved • advisory.com

25

Invest in services that cancer patients value most

Service Line Strategy Advisor research and analysis.

Key imperative 2

Design a patient-centered and convenient care experience to retain cancer patients throughout treatment

Offer specialized symptom management, co-located services, multidisciplinary clinics, and one point of

contact to help patients understand care

Engage patients in treatment decisions

Promote clinical quality online and strengthen referring provider relationships to attract cancer patients

Understand which quality measures and proxies for clinical quality are most meaningful to patients and

promote these on the cancer center’s website

Make the cancer center’s website easy to find and navigate

Understand what referring physicians are looking for in a cancer provider and craft a compelling message that

speaks to their needs

© 2020 Advisory Board • All rights reserved • advisory.com

26

Source: 2019 Trending Now In Cancer Care Survey.

Providers agree on reimbursement changes as top threat

Oncology Roundtable research and analysis.

49%48%

40%37%

34%32%

26%25%25%

24%21%21%21%

20%18%

15%13%

9%7%7%

2%

Cost of drugs

Marketplace competition

Physician alignment around services or program goals

Network strategy and integration

Managing staff and physician burnout from oncology field

Cuts to fee-for service reimbursement

Access to capital

Health IT

Quality reporting requirements

Increasing patient consumerism

Increasing expectations and needs of referring physicians

Which of the following are the biggest threats to future cancer program growth at your organization?1

Percentage of respondents that ranked threat in top five, 2019n=124

Reimbursement requirements from payers2

Shifting reimbursement away from fee-for-service to value based care3

Uncertainties in drug pricing reform policies4

Cost of new treatment processes/equipment5

Workforce planning6

Insurance shifting additional costs to patients7

Site-of-care policies issued by private payers8

Shifting drug channels9

Changes in health care coverage10

Shifting patient demographics11

1. Respondents were asked to rank up to five threats.

2. For example, prior authorization.

3. For example, Oncology Care Model, Radiation Oncology Model.

4. For example, 340B, changes to Medicare Part B drug pricing.

5. For example, new LINACS, CAR T-cell therapy.

6. For example, managing staff shortages, retaining

staff, recruiting staff.

7. For example, high-deductible health plans.

8. Only first infusion can be delivered in HOPD setting.

9. For example, PBMs, specialty pharmacies, white bagging.

10. For example, repeal of the individual

mandate, potential expansion of Medicare.

11. For example, having to care for an

older comorbid population.

Trend 3: Payers’ efforts to control oncology spend directly threaten providers’ growth

© 2020 Advisory Board • All rights reserved • advisory.com

27

125

137

151

173

2010 2014 2018

1. All numbers in 2010 US dollars.Source: Mariotto, A. et al, “Projections of the cost of cancer care in the United States: 2010-2020,” J Natl Cancer Inst. 103, no. 2, (2011):117-128.

ncbi.nlm.nih.gov/pubmed/21228314.; “Financial Burden of Cancer Care,” National Cancer Institute, 2019. progressreport.cancer.gov/after/economic_burden..

Oncology Roundtable interviews and analysis.

Estimated US direct cancer care costs

Billions USD1, 2010 - 2020

US cancer care expenditures in the billions–and rising

207A more aggressive

projection, accounting for

increases in the use of

targeted chemotherapies

2020

© 2020 Advisory Board • All rights reserved • advisory.com

28

Rising costs driving purchasers to target cancer spend

Oncology Roundtable interviews and analysis.

1

Drug costs

• Drug pricing reform

• 340B reimbursement

• Prior authorization

• Pathways

2

• Site neutrality

• Site-of-care policies

Site of care

3

Provider choice

• Network design

• Centers of excellence

• Value-based partnerships

Three areas of focus for payers and employers to control costs

© 2020 Advisory Board • All rights reserved • advisory.com

29

1. Respondents were asked to select all

that apply. If they selected “Unsure” or

“None of the above”, they could not

select any other answer.

2. Accountable care organization.

3. Excluding the OCM.

4. Including pathways compliance bonus.

Oncology no longer on the sidelines of value-based care

Service Line Strategy Advisor research and analysis.

What value-based contracts does your cancer program currently actively participate in?1

Percentage of respondents, 2019

n=124

Source: 2019 Trending Now In Cancer Care Survey.

31%

20%

19%

19%

14%

10%

9%

2%

19%

19%

Pay-for-performance

Direct-to-employer contracting

Capitated payment

Other

Unsure

None of the above

Shared savings or ACO2 model

Bundled payment, case-rate payment, and/or

episode-based payment with private payers3

CMMI’s Oncology Care Model (OCM)

Oncology Medical Home model

4

© 2020 Advisory Board • All rights reserved • advisory.com

30

Source: “CMS announces additional opportunities for clinicians to join innovative care approaches under the Quality Payment Program,” Centers for Medicare & Medicaid

Services, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-10-25.html; “Oncology Care Model Overview,”

Association of Community Cancer Centers, http://oi.accc-cancer.org/advocacy/OCM-Overview.asp; Strawbridge L, ACCC Oncology Care Model Collaborative Workshop

at the ACCC 44th Annual Meeting and Cancer Business Summit, Washington, DC, March 16, 2018; Hubbard A, “RO-APM: What we know, what we don’t and what it all

means,” ASTRO Blog, February 14, 2019, https://www.astro.org/Blog/February-2019/RO-APM-What-we-know,-what-we-don%E2%80%99t-and-what-it-all.

No end in sight for oncology payment reform

Service Line Strategy Advisor research and analysis.

Radiation Oncology Model

Proposed rule released July 2019; final rule

delayed, but expected by July 2022 at the latest

Prospective payment for radiation therapy services

provided to patients with one of 17 included

cancer during a 90-day episode of care subject to

a discount factor of 4% for professional component

and 5% for technical component; participants can

earn back withholds based on clinical data

reporting, quality measure reporting and

performance, and patient experience performance

Mandatory participation for all HOPDs, physician

group practices, and freestanding centers within

randomly selected CBSAs2

Oncology Care First Model

RFI for five-year pilot that would begin in January

2021 after the final OCM episode has started

Prospective monthly population payment that

“bundles” reimbursement for E&M, drug

administration, and seven enhanced services (e.g.,

patient navigation, electronic patient-reported

outcomes) for all medical oncology patients1; total

cost of care accountability for six-month episode with

opportunity to achieve a bonus based on costs and

quality for Part B and D chemotherapy patients only

Optional participation for physician group practices

and HOPDs that are paid under HOPPS

1. This includes patients receiving chemotherapy and hormonal therapy only, along with

patients who are not receiving any cancer-related drugs, such as survivors, who are still

seeing their medical oncologist as part of follow-up care.

2. Core-Based Statistical Areas.

© 2020 Advisory Board • All rights reserved • advisory.com

31

Build an agile organization that can adapt to unexpected reimbursement changes

Put the right infrastructure in place

Service Line Strategy Advisor research and analysis.

Key imperative 3

Take a principled approach to care transformation required to succeed under value-based contracts

Evaluate organizational readiness to adopt value-based contracts; consider organizational leadership and

culture, data analytics capability, and patient access and cross-continuum focus

Prioritize investments that will help you succeed under fee-for-service and value-based contracts, such as

evidence-based care, improved access, symptom management, and data infrastructure

Understand organization’s top opportunities for cost savings

Focus on prevention, informed screening, survivorship, and end-of-life care as levers to reduce total

population costs

Implement no-regret strategies to ensure financial sustainability

Understand financial performance and identify areas for improvement

Refine staffing model and processes in place to manage prior authorization and revenue cycle requirements

Invest in cancer patient financial navigation to improve patient care and revenue capture

© 2020 Advisory Board • All rights reserved • advisory.com

32

Program success hinges on adaptation to shifting landscape

Service Line Strategy Advisor research and analysis.

1

As cancer care becomes more complex, care teams will need new expertise and more training

Caring for more complex patients will require cancer programs to provide well-coordinated multidisciplinary care

delivered by a diverse and culturally competent team, while delivering more complex treatments will require cancer

programs to evaluate new investments to remain competitive, and to provide training, support, and new expertise to

help the core care team implement treatment innovations

3Rapidly changing reimbursement landscape necessitates cancer programs be agile to survive

Start by implementing no-regret strategies to ensure financial sustainability; tackling low-hanging fruit to improve quality

and reduce costs in a value-based world; and designing and optimizing network to manage patients within the system

at the lowest-cost, most appropriate site of care

2Cancer programs must invest in what matters most to patients to contend with increasing consumerism

Attracting patients requires cancer programs to differentiate themselves on quality, strengthen relationships with

referring providers, and develop an online presence; retaining patients requires cancer programs to provide a patient-

centered and convenient care experience

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How to respond today and how to prepare for the long-term impact

Your top resources for COVID-19 readiness

Advisory Board interviews and analysis.

To access the top COVID-19 resources,

visit advisory.com/covid-19

Links to external resources, such as:Advisory Board resources, such as:

CDC's hospital preparedness checklist Anatomy of an Outbreak: COVID-19 and

the U.S. Health Care Delivery System

CDC's health care personnel

preparedness checklist

Rebuild the Foundation for a

Resilient Workforce

CDC’s infection prevention and control

recommendations for COVID-19 patients

Coronavirus scenario planning: 12 situations

hospital leaders should prepare for

CDC's COVID-19 case tracker Managing clinical capacity

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