Payment Reform Through the Enhancing Oncology Model With Lalan Wilfong, MD

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here at the ASCO Annual Meeting, and I'm joined by Dr. Lalan Wilfong. Thanks so much for coming on today.

Lalan Wilfong, MD: Thanks for having me.

Oncology Data Advisor: Would you like to briefly introduce yourself and share what you do?

Dr. Wilfong: I'm Lalan Wilfong. I'm the Senior Vice President of Payer and Care Transformation for the US Oncology Network.

Oncology Data Advisor: So, you're presenting a session here at ASCO entitled, Payment Reform: Lessons Learned from the Oncology Care Model and Implications for the Enhancing Oncology Model. To start off, what is the Oncology Care Model and what does it address?

Dr. Wilfong: The Oncology Care Model was the value-based care program through the Centers for Medicare and Medicaid innovation, or CMMI. That ran from 2016 through 2021, basically looking at payment reform for oncology care and paying for value-based care versus traditional fee for service. And the Enhancing Oncology Model, which is the one that is due to start July 1st, is the next iteration of that model.

Oncology Data Advisor: What are the new factors that the new model incorporates?

Dr. Wilfong: The new model keeps some of the original tenets of the Oncology Care Model, really focusing on shared decision making, quality improvement with navigation, and reducing patient burden with hospitalizations and needed visits. But the Enhancing Oncology Model adds some elements around social determinants of health, as well as electronic patient-reported outcomes.

Oncology Data Advisor: Are there any other factors or directions under investigation that will be incorporated into the model in the future?

Dr. Wilfong: Some of the interesting things are electronic patient-reported outcomes. That's part of the model, but they haven't yet defined exactly what that means. It's still an area of active investigation of how best to incorporate electronic patient-reported outcomes (ePROs) into patient care, and so that is something that will be developed over the next one to two years before they implement that part of the model.

Oncology Data Advisor: So, in general, how can the efficiency of cancer care delivery be addressed while also maintaining and improving quality of care?

Dr. Wilfong: I think the big thing that we need to continually address is truly focusing on the patient. One of the things in the Oncology Care Model, which the Enhancing Oncology Model will continue, is patient-centered care, understanding patients' goals and values, so you can have shared decision making around the therapies you provide, and then surrounding that patient with the support they need to prevent poor outcomes such as toxicities that lead to hospitalizations, emergency department (ED) visits, things like that. So, by doing that, you reduce waste in the system where you can reduce cost and improve value to the patient by preventing poor outcomes and focusing the care on the patient.

Oncology Data Advisor: Does the Enhancing Oncology Model specifically focus on any health care providers, or does it incorporate oncologists, nurses, pharmacists etc.?

Dr. Wilfong: The Enhancing Oncology Model really focuses on medical oncology, those who give chemotherapy or antineoplastic therapy to patients. But it does include all of the services that we provide, including the nursing support, pharmacy support, financial support, and navigation support. All of those things are incorporated into the model.

Oncology Data Advisor: Do you have any advice or strategies for the various members in the multidisciplinary team, including nurses and pharmacists, who are trying to be involved?

Dr. Wilfong: The advice I have is to have a uniformed approach for your practice of how you address patients at need. Navigation is a big topic, but understanding who should be contacting the patient when and what objectives you're trying to accomplish with that is important. Who is best in the clinic to enable toxicity management, education around chemotherapy, financial support, and patients who have social determinative health needs? How do you best address those? It's important for practices to understand and have a plan of how they're going to address all of those issues.

Oncology Data Advisor: One last question I have for you is, since the theme of ASCO this year is "Partnering with Patients," do you have any examples or advice about how you partner with patients in their care?

Dr. Wilfong: I think one of the things the EOM is going to focus on, in addition to what the OCM did, is truly that patient partnership. Making sure that patients have a full understanding of the disease that they have, their prognosis, the treatment they're giving, and the potential outcomes and risks of that treatment is important to have that shared decision making with the patient. So, in order for a patient to have true decision making about the care they're receiving, we need to spend time and energy in educating them about those things, so they can make the best decision for themselves.

Oncology Data Advisor: Definitely. This is great. Thanks much for talking about this today.

Dr. Wilfong: Thank you.

About Dr. Wilfong

Lalan Wilfong, MD, is the Senior Vice President of Payer and Care Transformation for the US Oncology Network. Dr. Wilfong's passion revolves around building affordable and quality patient care through the Oncology Care Model and Enhancing Oncology Model. His research focuses on patient care, doctor-patient communication, enhancing end-of-life care, and overall improving patient quality of life.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.