The New Role of Cancer Patient Engagement in Value Based Models

Transcription

1 Mini Summit XIX: Case Studies in Specialty Medical Homes: How to Design APMs to Support Patients with Serious Health Conditions that Cannot be Managed by a PCP Ray Page, DO PhD

2 The New Role of Cancer Patient Engagement in Value Based Models

3 Crisis Intervention How can a community oncology practice transform to adapt to MACRA/MIPS/OCM? Dilemma: Every aspect of the market is rapidly trending toward value-based APMs most oncology groups practice technically and culturally only with structures to treat patients in a Fee-for-Service (FFS) environment.

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5 Use everyone to the top of their training Team approach in patient care NP/PA, hospital NP MA Triage nurses Pharmacy Team approach in documentation? Virtual Scribe Additional MA Back office coders

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7 COME HOME Program (Community Oncology MEdical HOME) Barbara McAneny, M.D., Innovative Oncology Business Solutions (IOBS) Name of the $19.8M CMMI grant 7 U.S. practices Patients managed under OMH structure Centralized, protocol-driven triage nurses Expanded office hours, 24/7 clinical staff access Treatment pathway development and compliance Laboratory/Molecular diagnostics efficiency McAneny, J. Managed Care, 2013, SP41-42

8 How do Oncologists Currently Technically Operate in a FFS Environment? Decentralized Processes Poor palliative care Patient Intake Phone Triage Limited support systems Limited survivor -ship Patient Symptom management Individual schedule templates Psychosocial support

9 How do Oncologists Currently Technically Operate in a FFS Environment? Physicians fixing problems in exam room, no team approach Chemo regimen du jour Clinical focus treating disease, not healing lives Nursing focus treating immediate cause, not the bigger cause chemo room triage Satellite clinics focus on ownership of their patients Limited coordination of post ER or hospital stay

10 Implementing OMH Model Changing a practice technically and culturally Dedicated triage nurses, centralized phones Scripted triage pathways Expanded hours and dedicated triage clinic time Navigators/Nurse educators Coordinated emergency/hospital management Treatment Pathways Patient portal and communication Clinical Trials Support Psychosocial distress evaluation Survivorship Clinic

11 Oncology Medical Home (OMH) Commission on Cancer (CoC) Accreditation Pilot Program

12 Aetna OMH Shared Savings Pilot Three practices, strong infrastructure support Numerous practices now engaged in similar model Enhanced data sharing, benchmark data for shared cost savings Medical Patient Management fee: Reimbursement set up through Transition of Care and S code billing Prior authorization relief Quality metrics

13 Elements of Quality Measures Resulting in Patient satisfaction End-of-life metrics (ACP documentation, hospice enrollment, hospice length of stay) Shared Savings ER visits (and costs) Hospitalization rates (and costs) Adherence to evidence-based treatment guidelines (including off pathways reasons) Cancer staging, performance status, pain assessment Chemotherapy costs

14 .. Recommendations: Policymakers should focus on creating value-based incentives that raise quality and lower cost rather than arbitrarily cutting payment levels based on the site of care. ensure that payment levels for physician practices provide adequate support for the full scope of medical and ancillary services required to treat individuals with cancer. engage in additional study of the full scope of services required by patients with cancer, including the specific needs of low-income individuals, before implementing any change in resources paid to oncology practices and hospitals....transform Medicare coding and payment for outpatient cancer care by implementing policies that are consistent with proposals such as the ASCO patient-centered oncology payment proposal and the CMS design for an oncology-focused model of care.

15 Foundation for Success with Alternative Payment Models Triage pathways Centralized phone triage Expanded hours on weekend Better Care for Patients Dedicated schedule of patient triage times Treatment pathways Financially Viable Physician Practices Lower Spending for Payers