🔒Greater Hartford cancer care moves toward performance-based model

On July 1, the Center for Medicare and Medicaid Services (CMS) launched a new five-year trial program that aims to make Medicare patient cancer treatment more coordinated and cost effective.

Rocky Hill-based Starling Physicians, which formed last year through the merger of two physician groups with more than 250 providers, is among 195 physician groups nationwide — including three in Connecticut — that were officially accepted into the Oncology Care Model (OCM) program.

In exchange for their efforts, participating physician groups will receive a $160 monthly payment from CMS for each patient treated under the program. They will also have the chance to earn performance-based payments tied to cost savings and quality measures.

OCM is one of many CMS initiatives that are pushing providers away from the long-dominant fee-for-service model and towards population-based or “accountable care” contracts.

Q&A talks about the OCM program with Tracy King, Starling's chief integration officer.

Q: Why did Starling apply to join the OCM program?

A: Starling has always endeavored to provide whole-patient-centered care to oncology patients. The CMS OCM model recognizes the resources required to make oncology care truly comprehensive and provides some of those resources so practices like Starling can make the investments in technology and personnel to fully develop a comprehensive care delivery model. This program helps us more fully realize our goal of providing comprehensive, whole-patient-centered care.

Q: What sorts of patients will you be seeing under this program?

A: This program is for patients with traditional Medicare coverage. In addition to our historic standard of care, which follows evidence-based clinical guidelines and pairs each patient with a physician/advanced-practice nurse team, the OCM program will allow us to expand our team with nurse navigators and social workers to address patients' comprehensive medical and psychosocial care needs while they are receiving cancer treatment with Starling Physicians.

We are in discussions with health plans that cover other patients to expand this model to support those patients as well.

Q: Starling was formed last year through the merger of Grove Hill Medical Centers and Connecticut Multispecialty Group. Does the fact that you are larger help you as you enter this new initiative? 

A: Overall, the combined size of Starling will allow us to make the investments needed to provide more comprehensive, whole-patient-centered care for the populations we serve.

Starling has a larger geographic footprint now and serves multiple hospitals with multiple specialties.

Our oncology division exists within a larger, multispecialty group that is finding ways to make these kind of investments in all of our clinical areas.

Our size allows us to serve more of our patients with our own providers, when they need the help of a specialist or in the hospital.

However, in the OCM program nationally, we are one of the smaller programs, and that's because this is a big commitment.

Q: How does CMS' push toward coordinated, population-based care compare to what you are seeing from commercial payers?

A: The OCM is more comprehensive and better defined than some of the commercial programs we've discussed with the commercial payers.

Many of them are moving in this direction at this time, and we're encouraging them to do so. The OCM requires medical practices to analyze patients' needs and their medical issues very closely, so we can best understand the population we care for.

We think that the OCM model, or some variation on that model, should be the model of care for all patients receiving cancer treatment, based on clinical-evidence, with highly personalized attention to patients' clinical and psychosocial needs.