How Can Practices Seek Success With Oncology Payment Reform?

At the Payer Exchange Summit V, sponsored by the Community Oncology Alliance (COA), held October 24-25, 2016, in Tyson’s Corner, Virginia, Bruce Gould, MD, medical director, Northwest Georgia Oncology Center, presented an overview of how cancer care has improved over the years, what the challenges are, and how practices can adapt to payment reform.

“The number of new cancer cases and survivors are expected to rise,” Gould said. “Survivors will increase from 11.7 million in 2007 to 18 million in 2020. Patients are living longer, especially with multiple treatment options available—however, the new treatments are expensive.” Melanoma, for example, has seen a significant improvement in patient survival, especially after the checkpoint inhibitors arrived on the scene. “But these drugs come with a significant price tag,” Gould said.

Gould went on to share the findings of a Milliman report, commissioned by COA, that did a cost of care analysis to identify drivers of cancer care costs. “Hospitals—academic ones in particular, were identified as major cost drivers,” he said. “There’s a significant consolidation of practices with hospitals, and cost of care is definitely much higher in hospitals than in private practice.”

What is COA doing about this? Gould described the Oncology Medical Home (OMH) model, which was initiated by COA, as well as the associated accreditation program.

“We have been speaking about the OMH concepts across the country with various practices, and several institutions have been adopting this care model,” Gould said. OMH assures practices better value for the dollars spent, provide patients care at home, and is a path to cost savings, he added.

The OMH accreditation program helps validation of compliance standards, appropriate structures and processes, and the need to have an EHR, Gould told the audience. “Further, there are 5 domains of care that are the primary focus of the program, namely: patient engagement, expanded access, comprehensive team-based care, evidence-based medicine, and quality improvement projects,” Gould said. He then highlighted some of the nuances of the various domains:

1. Patient engagement, he said, includes financial counseling, patient education on OMH benefits, engaging patients in treatment planning, a patient portal to allow communication with the practice, and actively including specialty trained nurses in patient care.
2. Expanded access includes same-day appointments, structured triage, and 24-hour patient access to a doctor or nurse.
3. Team-based care, he said, includes dividing a care navigator’s job among the practice staff. The practice also sets up relations with outside providers for non-urgent care, psychosocial care, discussions on end-of-life care, etc.
4. Quality improvement projects include quality improvement methods that are developed and implemented, patient surveys to get feedback, and evaluation of how the survey results inform practice performance.

“COA has multiple projects and has commissioned several studies to address these issues,” Gould said.