Allina Health: Bringing Population Health Strategies to Oncology

Three years ago, Allina Health, a not-for-profit health system that operates 10 hospitals and more than 90 clinics in Minnesota and western Wisconsin, decided to invest in cancer care with a population health focus. Doing so required Allina to "remap the patient experience” in cancer care, according to Mike Koroscik, vice president, Oncology, Allina Health Cancer Institute (AHCI).

On Friday, Koroscik offered an update on how that process has evolved for AHCI, which launched in October 2021. Koroscik presented “Preparing for Population Health in Oncology,” during the Association of Community Cancer Centers 39th National Oncology Conference, which concluded in West Palm Beach, Florida.

His talk is part of the emerging consensus that improving patient experience and bringing down cancer costs calls for prevention through healthier living or catching cancer early when it is easier and less expensive to treat. The second approach requires using data and risk stratification strategies to screen patients and to rethink reimbursement, which would have to reward health systems based on a population health model, rather than only paying for testing based on individual patient risk.

Koroscik began by discussing why population health in oncology “is in vogue.” Although Allina made its commitment before the pandemic, COVID-19 highlighted the enormous need for a population health approach, and the “silver linings” of that experience are fueling some of AHCI’s early steps.

“Cancer care was disjointed,” Koroscik said. “Even mapping our largest cancer type—breast cancer—had over 33 touch points” before the AHCI overhaul began. Clearly, an intervention that revamped the traditional “hub and spoke” relationship between flagship and rural sites had to be rebuilt.

“We knew our value proposition was redefining cancer care, making it accessible,” he said. “We had to focus on a new network.”

In August 2020, Allina Health reached an agreement on what was described as a “landmark” value-based contract with Blue Cross Blue Shield of Minnesota, and Koroscik said larger payers are the focus of AHCI’s efforts in value-based care.

From there, he said the AHCI model would be one of accessible, “seamless connections” that recognizes the multiple factors—mind, body, and spirit—that affect overall health. It includes:

• Integration of primary care and mental health
• A patient financial navigation program that addresses financial toxicity
• Exceeding expectations on screening and surveillance
• Convenient hours and availability of urgent care, to reduce emergency department (ED) visits and hospital admissions
• Better utilization of nurse navigators, “to thrive, not just survive” under bundled payment arrangements
• Upfront engagement of payers in innovative population health initiatives, which include social and community-based initiatives.

Lessons from COVID-19. The sharp drop in cancer screening that took place in the early months of the pandemic—and the resulting cancers that followed—build the case for an emphasis on preventive care and addressing social needs. “The numbers were devastating,” Koroscik said.

But building a patient-centered, population health-focused oncology model necessarily “depends on finding a sustainable path forward,” Koroscik said, so cost control is part of the picture. At the “macro level,” that means building a model based on evidence-based care, minimizing care variation, and paying attention to the total cost of care. Other interventions will focus on:

• Reducing acute care crises
• Fewer ED visits, hospital admissions, and reduced length of stay
• Improved care transitions and care management
• Appropriate site of care, including home care where appropriate

Typical characteristics of value-based care agreements are benchmarks based on the total cost of care, shared savings, and pay-for-performance. Adding population health to oncology care will put more focus on risk adjustment, Koroscik said. Palliative care will continue to gain attention, as will minimizing unnecessary variation in care.

To support these agreements, Allina Health will rely on informatics support that goes beyond traditional pathways to more “real time” assessment, and better panel management. Koroscik reviewed the elements that go into a “composite risk score,” which is a metric and decision tool that reflects the urgency of the patient’s situation, the depth of clinical need, financial risk, social determinants of health, and likelihood of adherence.

“For us, this is a real game changer,” he said. This is where Allina Health can change incentives for physicians to align with quality targets, reduce variation, and improve outcomes.

Current areas of focus are ED avoidance, clinical pathways—medical, radiation, and surgical—shifting symptom management near the infusion center, the home hospital program, lung cancer screening, and encouraging serious illness conversations. Looking ahead, Koroscik is mindful of what is coming from CMS in alternative payment models (APMs), including the long-delayed Radiation Oncology Model that will likely reduce payments. Gathering data now is essential to be ready for when the APM arrives, he said.

Allina Health is trying new things: 18,000 patients have been screened as part of a social vulnerability pilot, and Koroscik said there are programs for LGBTQ populations and Minnesota’s Somali community.
In their work with payers, he said, it’s important to keep in mind that “bundles might be good, or they might not be good,” depending on the population.

What’s critical is data. Even getting a basic measure such as how many patients have accessed the ED at 30 days isn’t always simple.

“Only 10 years ago I was data starved,” Koroscik said. “I don't have too much data, but it's getting the right data.”