April 25, 2022 — Episodes of care are payment programs in rapidly expanding value-based care models. These programs often provide a prospective payment for the entirety of a patient’s care delivered over a defined period of time. 

Episodes of care programs allow for physicians to deliver holistic, patient-centric care without the complexity of many of the administrative burdens that often create inefficiencies in care delivery. While episodes of care are straightforward in surgical procedures that have a defined construct and time horizon, in oncology, episodes of care aren’t as clear cut.

Cancer is complex and not neatly defined. There can be tremendous variation in the initial diagnosis and treatment planning due to factors including the pathologic features, stage of disease, types of treatments provided, genomic profile, and other risk factors. All of this contributes to the difficulty of defining specific episodes of care in oncology.

Still, an episodes of care analysis was the underlying approach to the Oncology Care Model and is a growing component to value-based contracting arrangements in oncology today. While capitation and sub-capitation arrangements may be simpler to devise, the high variation in cost associated with treatment of specific cancer conditions makes this broad-brush approach sub-optimal to drive the true goal: Reducing the cost and improving outcomes for each individual cancer patient.

As highlighted recently in a JAMA article, episodes-based models may be complementary to growing population-based capitation models through a hierarchical structure, whereby an Accountable Care Organization, or risk-bearing primary care provider, is responsible for global spend, but ensures that specialists are delivering high-quality, cost-efficient episodic care. 

A Platform Approach

There are too many cancer conditions to create an episodes-based program for every single cancer condition. At OneOncology, our view is that we can deliver meaningfully better outcomes at lower costs by distilling the complexity of cancer down into distinct cancer episodes, which can provide a structured methodology to personalize care and iteratively optimize the care for high-cost, high-acuity cancer patients. 

Our episodes of care models are designed by disease experts in each specialty and supported by a robust clinical analytics platform. We then use our collection of value-enabling tools to empower oncologists to deliver the right treatment at the right time with the right portfolio of supportive services for the right time duration.

From comprehensive next generation sequencing and value-based regimen choices to high-value clinical trials and biomarker analysis, OneOncology’s toolkit delivers what oncologists need when they need it. And since episodic care puts patients at the center, the platform also brings oncology partners value-creating services from navigation and social work to approaches to palliative care or hospice.

Organizations such as OneOncology are uniquely positioned and empowered to achieve success due to our robust access to longitudinal data and clinical leadership. This enables development of models informed both by historical treatment patterns and rapidly evolving changes to standard of care.

A First: Episode of Care for NSCLC

We began episodes of care in early-stage breast cancer, a cancer with less variation, and expanded the program to locally advanced lung, colorectal, head and neck and prostate cancers. These episodes utilize combined modality care delivered by medical and radiation oncologists. OneOncology is now embarking on an episodes of care model for metastatic non-small cell lung cancer (NSCLC), which will be a first in this disease state.

NSCLC is heterogeneous group of medical conditions in patients that often have multiple comorbidities. The complexity of the disease leads to considerable variance related to physician treatment decisions, care management services required, clinical, and financial outcomes for patients. 

The significant variation in treatment options and high total cost of care across this diverse group of patients presents an opportunity to define treatment decision-making more precisely at the point of care as well as care navigation approaches to deliver personalized, high-value care at the most responsible cost. Developing an episodes of care model for NSCLC, which accounts for an estimated 85% of lung cancer cases comprising adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, won’t be simple. But with OneOncology’s platform of value-enabling tools, we can give oncologists the information they need, when they need it, and in the way they need it to transform cancer care.