An Update on the Oncology Medical Home Model at the COA Conference

Providing quality care that values the requirements and needs of individual patients, in an integrated and comprehensive manner and at lower costs—that is the premise of the Oncology Medical Home (OMH). There have been several advances and improvements in OMH, and accreditation of the model, being implemented by the American College of Surgeons’ Commission on Cancer (CoC) has further strengthened the process to ensure the delivery of quality cancer care.

Representatives from 3 of the clinics that successfully participated in the CoC accreditation process sat on a panel on the first day of The Community Oncology Conference: Innovation in Cancer Care. The panelists included Marsha DeVita, ANP-BC, chief clinical officer, Hematology Oncology Associates of Central New York; Bruce J. Gould, MD, president and medical director, Northwest Georgia Oncology Centers, PC; and Barbara McAneny, MD, chief executive officer, New Mexico Cancer Center & Innovative Oncology Business Solutions. McAneny has also been responsible for the COME HOME project.

Gould provided a historic perspective on how OMH evolved years ago. COA had a board member, John Sporandio, MD, who presented a new oncology care practice model to the COA board in early 2011. “This was a model that he followed in his clinic in Philadelphia—a more patient-centered model that was cost saving. He called it the OMH model,” Gould said. “But this was a single practice in Philadelphia. So COA decided to expand on it and gathered input from diverse stakeholders, including patients, patient advocates, payers, and providers. We refined and defined the model with input from our steering committee,” he added.

Gould explained that the model places tremendous emphasis on patient values. “Patients want more engagement in decision making, easy access to patients, insurance navigation, not wanting to call 911, etc. Payers are more focused on standardizing care and differences in reimbursement based on site of care.”

But there’s a lot that physicians do for patients, such as financial counseling, that they are not reimbursed for he said. “So we came up with processes of care such as a triage pathways; having frank end-of-life discussions—and generating the relevant paperwork for it—among many others. We also developed quality measures that are reported to payers and other stakeholders. But the focus is on the patient,” added Gould. “We then developed a patient survey to understand how they view the value of their quality of care. This has been adopted by payers such as Aetna as well.” Practices can access patient feedback and try to improve and reengineer how things are managed in the clinic so they can meet their patients’ expectations.

“We have been working with CoC to develop the medical accreditation program. We have 10 accredited medical homes in a span of 1 year,” said Gould.

McAneny, who has initiated the COME HOME project at her clinic in New Mexico, introduced that audience to the triage system followed at their clinic, which has a substantial impact on the efficiency, patient quality of care, and cost. “In my practice in New Mexico, where we take care of a significant number of less privileged patients, we have to deal with a lot of issues with how we ensure patients get the care they need,” she said. Considering the increasing cost of care, cancer patients are twice as likely to go bankrupt she said.

McAneny explained that her clinic received funding from the Center for Medicare and Medicaid Innovation (CMMI) to develop a model that can redefine quality care and save costs. “Through this model we defined episodes of care and quality measures. We also asked ‘What do patients value most?’” she said. The COME HOME project was the result of the CMMI grant, and it incorporated patient and practice experience.

An important focus of their model is triage. “We made sure that when patients call in, they could speak to someone who understood their case, the drugs they took, and the side effects they are susceptible to,” all in an effort to ensure quality and keep costs low. “If they can stay out of the hospital, it can’t just control costs, but also keep patients healthy,” she emphasized.

McAneny said that their triage pathways are built to understand the symptom-specific pathways. “We are working hard to ensure our nurses are trained to do that. We found that we can ensure savings for patients, practices, and the healthcare system as a whole by keeping the patient out of the hospital.” She then provided details on the triage system and the patient data that the nurses access to help them manage their symptoms when they call in.

“We have to be able to manage the patients, have to ensure that they get what they need, and we need to have an adequate system in place to support the process. This will help keep patients out of the hospital and to keep the costs low,” she affirmed.

DeVita, a nurse practitioner, provided insight into the working of their practice in New York. “We were part of the CoC pilot of OMH. It’s all about the quality of care, value of care, and being patient-centered. This being central to our practice, it helped us get structure to what we did and to do it right.” Patient access was most important, according to DeVita. “OMH gave us better handle on our daily working to ensure patients get access as they call in. Telephone triage is also extremely important, she said. This has been very valuable to help take care of patients at the early stage before it becomes an emergency.”

DeVita emphasized that patient education is of utmost importance to ensure they understand the process. She said that their clinic has developed the most comprehensive approach to care, with services that range from financial navigation, clinical, and psychosocial support. “Our practice provides team-based care which involves a physician, a nurse practitioner, a registered nurse, and a navigator.” Every morning the team holds a “huddle” to exchange information on all the patients scheduled for a clinic visit that day. The broader team, she said, includes social workers, a dietician, and a cancer rehabilitation specialist.

“Quality feedback from the patient is extremely important to help improve our performance. So OMH helps restructure the clinic’s functioning and also allows continuous feedback-based improvements. We do consider individualized values and needs of each patient and translate them into the care delivered to them,” said DeVita.