Implementing Practice Transformation, Integrating Primary Care to Provide High-Quality Cancer Care

As practices work to provide the best care for their patients while also containing costs, it has become clear that the old ways of doing things won’t cut it. As a result, practice transformation has become a norm for many practices looking to succeed under value-based care models, such as the Oncology Care Model (OCM).

For Jefferson Health, the process began a decade ago as the health system decided to develop a multidisciplinary geriatric oncology evaluation center, explained Andrew E. Chapman, DO, FACP, chief of cancer services at Sidney Kimmel Cancer Center, during the second half of The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® (IVBM) session held September 19, 2019, in Philadelphia, Pennsylvania.

The center implemented a team-based model, bringing together social work, pharmacy, nutrition, and medical oncology. What it learned, explained Chapman, was that the group of patients—aged 65 years and older and account for the majority of cancer diagnoses, deaths, and survivors—are a significantly vulnerable population due to confounding factors, such as comorbidities and polypharmacy.

This, coupled with a fragmented healthcare system, caused Jefferson Health to step back and ask, “How can we think about how to address these cracks and think about this patient population in this fragmented system, and can we do something better?”

From there, the health system started down the path of practice transformation. This process was heightened as the National Committee for Quality Assurance introduced its Patient-Centered Medical Home Model and even more so with CMS’ introduction of the OCM.

Thinking about what needed to be addressed throughout the process, Jefferson Health came away with multiple aspects of care it wanted to implement, including team-based care, patient care management, and care coordination.

From there, Jefferson Health worked on building the infrastructure of a system that could withstand the changes needed, facilitating engagement with providers by creating a culture in which they understood how interrelated they are to the healthcare delivery system, and offering assessment to the providers by providing them data and feedback.

“The oncology care model for us has been this test tube for us to try and test really different opportunities in terms of building this infrastructure, sharing these data analytics, and trying to really evolve as a practice,” said Chapman.

Flash forward to 2019, and Jefferson Health has laid out a series of goals it wants to act on:

• Develop and execute a strategy for addressing care needs across the continuum of care through navigation and supportive medicine
• Execute a strategy to reduce cost and care variation
• Demonstrate improvement in guiding patient to the appropriate site of care and creating meaningful care goals
• Disseminate this data through a community strategy so that providers understand what is being measured and why it’s important
• Share this information with providers

Throughout the year, there have been several goals that Jefferson Health has addressed. The health system has taken on unnecessary care variation by creating a data operationalization strategy aimed at understanding the drivers of clinical and cost variation in practice, facilitating an oncology navigation team to focus on care coordination and outcomes and outreach, and implementing a pathway system.

It has also worked on guiding patients to the appropriate site of care by looking at how to reduce avoidable emergency department (ED) use. Looking at baseline data on patients visiting the ED who did not got admitted, it found that just shy of 50% of those patients are going to the ED while the clinic is open.

“We saw this as a huge opportunity to say, ‘How can we leverage the triage algorithms that we built for all the different symptoms, and how can we leverage our same-day clinic where patients can be immediately plugged to when they call the practice?’” Chapman said.

The health system, as a response, started an education campaign to educate both providers and patients about the importance of calling the practice beforehand to ensure direction to the appropriate site of care.

Taking on a third goal, the health system opened up the Neu Center for Supportive Medicine & Cancer Survivorship, which this year has screened nearly 900 patients for distress and has facilitated advanced care planning discussions early on between providers and their patients.

Looking ahead, Chapman outlined several challenges for the coming year, including scaling capabilities; implementing programs to manage high-risk or targeted populations; and engaging primary care and specialty practices.

A focus on primary care

Integrating and engaging primary care in cancer care and cancer survivorship has been of high interest to not just Jefferson Health. During IVBM, Kelly Filchner, MSN, director, Fox Chase Cancer Center Partners, walked through how the cancer center integrated primary care into oncology patient management.

“Primary care physicians believe they are an integral part of cancer care but they need the tools to be part of that team,” she explained. For Fox Chase Cancer Center, this plays an especially important role in survivorship.

With the realization that many patients transitioning out of their oncology care did not have a primary care provider (PCP), the cancer center created the Fox Chase Cancer Center Care Connect. The team started by going out and finding and building relationships with PCPs in the area.

It also set clear goals of what value it intended to get out of the program. For providers, Fox Chase wanted to ensure effective access and communication with the cancer center, improve physician metrics, and enhance shared collaboration and support of a growing survivorship population.

For the cancer center, there were goals of improving the transition of patient to survivor; providing an opportunity for screening, risk, and diagnostic services; and dispelling the notion that Fox Chase is only a place for cancer treatment.

“You can’t just create a program and then let it be on its own. You have to constantly be doing something, you have to constantly be monitoring,” explained Filchner.

Currently, the program includes 33 PCP practices representing 50 family medicine or internal medicine physicians and 22 mid-level practitioners. The program also includes 3 obstetricians and gynecologists, noted Filchner. To date, the program has referred 300 patients who did not have a PCP.