Commission on Cancer and the Oncology Medical Home

Effective January 2015, the Commission on Cancer (CoC) will be accrediting the initial pilot practices for Oncology Medical Home (OMH) recognition. The development of the standards for an OMH has been a collaborative effort among multiple stakeholders. Initial discussions that began 2 years ago with some community-based oncology teams has led to a concerted effort to standardize and endorse quality and value-based cancer care delivered by teams within the community or at other sites of care. Considerable time has been spent to develop the standards and requirements responsible for meaningful improvements in cancer care.

Established by the American College of Surgeons in 1922, the multidisciplinary CoC has been the leader in cancer program improvement. CoC’s mission is to improve quality of life and survival for cancer patients. This can be accomplished by:

• establishing standards to ensure quality, multidisciplinary, and comprehensive cancer care delivery in different healthcare settings

• conducting surveys in healthcare settings to assess compliance with standards

• collecting standardized data from accredited healthcare settings to measure the quality of cancer care

• using data to monitor treatment patterns and outcomes, and enhance cancer control and clinical surveillance activities

• developing effective educational interventions to improve cancer prevention, early detection, cancer care delivery, and outcomes in healthcare settings.

Currently, more than 1500 hospital-based cancer programs are accredited by the CoC. The OMH recognition program is the most recent accreditation program to be implemented by the 54-member cancer care organizations that direct CoC activities. This new model of care is intended to ensure highquality, measurable cancer care in a more efficient system by improving care coordination, expanding patient access to healthcare providers, and ensuring that care is delivered in a patient-focused manner.

Medical homes in primary care have been successful in improving the quality of care delivered and reducing the costs of that care. Cancer care practices or centers will need to implement all OMH standards and participate in an onsite survey to review their compliance with standards in 5 domains (Figure):

• patient engagement

• expanded access

• evidence-based medicine

• comprehensive team-based care

• quality improvement

This program, and subsequent surveys will promote organizational infrastructure changes in cancer care, resulting in process improvements for components of the 5 domains. These policies and procedures will include evaluation and measurement criteria that will demonstrate the results of the efforts of the centers to comply with these new standards. In this era of increased quality, care coordination, and accountability in healthcare, this will be a welcome addition for all involved—particularly cancer patients and their families.

For example, the patient engagement domain contains standards specific to educating the patient, providing guidance for managing the financial burden of cancer care, and providing a documented treatment plan for each patient. Not only will cancer care organizations need detailed, written policies and procedures for each of these processes, they will also have to prove that each required standard was implemented. They will need to demonstrate how they assist with patient education, report whatever aid is offered to patients, and assure that key components and goals of a patient’s care plan are shared on a timely basis. These are only a few examples of important issues in cancer patient care that are addressed in the CoC OMH accreditation standards.

The above collaborative effort is in conjunction with other initiatives to identify and promote quality and value in cancer care. These initiatives, and related teams, are working together to provide input, resources, and other standards that are used in the accreditation effort. These resources compliment the CoC OMH accreditation program in the following ways:

1. OMH Steering Committee. The measurement and overall direction of the oncology medical project is led by a team of thought leaders that includes 16 representatives from the patient, provider, payer, and advocacy communities. The list of objective quality measures in the accreditation program is the direct result of their coordinated vision to improve the quality of care, to deliver efficient care, and to reduce costs.

2. OMH Implementation Committee. The transition from a legacy-type cancer care system to one with a core emphasis on quantifiable improvement and quality can be challenging and time-consuming for cancer care teams entrusted with caring for cancer patients and their families. This leadership team is responsible for identifying resources that could help ease the administrative and financial burdens associated with the transition in care. In fact, it has already identified ways to assist practices with implementing the policies they need to follow to meet the standards described in the CoC OMH accreditation program. The OMH Implementation Committee has also been responsible for the design and deployment of the National Oncology Patient Satisfaction

Survey, another standard and key component of the CoC OMH accreditation program.

EBO

The CoC OMH accreditation program is deploying at a time when it is crucial to not only improve the quality of cancer care, but also make that care more efficient and cost-effective. This fresh attention to applicable, meaningful, and measurable improvement in quality and value emphasizes transparency and a better understanding of the processes for those involved in cancer care. The goal for all aspects of this model is to promote quality improvements in cancer care that are better measured, acknowledged, and recognized by all who may be involved in the cancer care system, including cancer care teams, employers, insurance companies, advocacy organizations, and patients and their families.

Daniel P. McKellar, MD, FACS, is chair, Commission on Cancer.

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