Andrew York: Value-Based Care and the OCM


Journal of Clinical Pathways spoke with Andrew York, PharmD, a CMS pharmacist, regarding the payer’s role—specifically, the Oncology Care Model’s role—in the transition towards value-based care (September 8-10, 2017; Washington, DC).

My name is Andrew York and I work with CMS on the Oncology Care Model, specializing in quality measure development as well as developing the practice redesign activities, including the requirement to use clinical guidelines as part of the model as a member of the OCM team.

What was the biggest takeaway that the audience could gleam from your presentation?

The biggest takeaway was that we think that clinical pathways are an important tool for a lot of our oncology practices to meet the needs of our patients by making sure that they are following evidence-based guidelines. That is going to help them meet the ultimate goals of improving care while also reducing costs.

How do programs on pathways in the OCM benefit patients, providers, and payers?

I think we all have the same goal of increasing and improving the quality of care while also reducing the cost of care. That would be a win for all of the folks you just mentioned. For the payers, we are obviously looking to reduce the cost of care but also ensuring that we maintain the quality of care for providers. That means they’re going to be helping their patients in a way that’s truly meaningful. The patients themselves should see it in high quality care as well as reduced cost for them. That’s a very important thing in oncology care and an increasingly important element for oncology patients today.

Was there any session at the Clinical Pathways Congress that you found meaningful for your work?

Yes. It was great to hear the other speakers talk about how they’re incorporating pathways into their work. One of the things that I will say as a person from the payer side is that we don’t always see what these products look like in person. Seeing how the different pathways work on the ground is really important for us.