Oncology Medical Home: A New Model to Improve the Healthcare Delivery System
As the healthcare system transitions to a more patient centered approach, new care models have been developed to provide coordinated care across organizations to reduce costs and improve care. One such model is the Patient Centered Medical Home (PCMH), a team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes.
Medical home models may allow better access to health care, increased satisfaction with care, and improved health. Care coordination is an essential component of the PCMH and requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-face patient encounter may help encourage coordination. Payers are actively moving toward paying oncology clinics differently who follow this approach.
As practices are starting to implement technology to meet Meaningful Use patient centered care requirements, they should also consider how that technology could be used to address new medical home models as well.
Primary Care Standards vs. Oncology Care Standards
The National Committee for Quality Assurance (NCQA) has developed six standards as a guide to help primary care practices qualify for PCMH accreditation. The table below shows more details for each standard, and the specific measures required to accomplish each of the six.
The NCQA model was developed with the primary care practice in mind. When patients are diagnosed with cancer, their oncologist becomes their primary caregiver during treatment, and the standards of care become specific to their condition. Although NCQA has not yet defined a model for specialty physicians, these standards are being used as a guide for payers and providers who are looking to test these models in oncology.
To address this new model, the Community Oncology Alliance (COA) has been working on their own set of medical home standards and recently announced their Medical Home Committee has approved 16 quality measures to help provide a guide to oncology practices as they move to adopt new medical home care models. These measures will be used to recognize and reward quality, value and positive outcomes in cancer care, and will help all stakeholders in the program agree on a common set of measures by which all participants can be evaluated.
To date, Consultants in Medical Oncology and Hematology (CMOH), lead by Dr. John Sprandio in southeastern Pennsylvania, is the only community oncology practice to achieve level-3 PCMH certification from NCQA. Last year we wrote about Dr. Sprandio’s oncology PCMH model, the nine standards he had to meet to achieve level-3 certification, and his results. With their medical home model, CMOH was able to reduce ER admissions and clinic calls that resulted in ER referrals, while increasing the number of patients treated with the same number of physicians and a decrease in office staff. Notably, all the advancements the practice made since adopting their PCMH model they have attributed to their health IT systems, which allowed them to measure and evaluate their performance.
Technology Key to Oncology Medical Home Performance Tracking and Engagement
Technology will play an important role in tracking performance for the PCMH quality measures, as well as connecting patients to their healthcare team and their own health information, so they can be more engaged in their care.
Most practices are currently focused on solving the Meaningful Use objectives. The PCMH standards are closely aligned with the Meaningful Use objectives, so practices should consider the big picture when evaluating Meaningful Use technology solutions. Administrators should ask themselves, “Is this a solution that can help me meet the requirements of other programs, or is it solely focused on achieving Meaningful Use?”
For example, one common performance measure is a reduction in ER admissions. To do this, the NCQA standards require practices to engage patients in self-management and support, such as symptom and side effect tracking so that practice staff can make interventions to avoid costly ER admissions. Our Patient Engagement Portal offers patients a Daily Health Journal for them to track their symptoms and side effects, which can be shared with their healthcare team in between office visits. It will also automatically alert the healthcare team if a patient or caregiver records severe symptoms so clinic staff can follow up with them immediately.
Oncology Medical Home Pilot Programs Under Way
Two oncology practices are in different stages of moving forward with medical home pilot programs. Dr. Barbara McAneny, CEO of New Mexico Cancer Center, was recently awarded a $19M grant from the Centers for Medicare and Medicaid Services (CMS) to develop seven oncology medical homes in New Mexico, Florida, Georgia, Maine, Ohio, Pennsylvania and Tennessee.
Wilshire Oncology has been working with Anthem Blue Cross Wellpoint, the largest payer in California, in a patient-centered medical home pilot since August of 2011. They worked with the health plan to develop a payment plan that supported the practice’s delivery of the most cost-effective, evidenced-based therapy and supportive care regimens. In addition, they developed a payment system for care planning that includes care coordination across different treatments and supportive services including rehabilitation, physical therapy, and end-of-life care. Data analysis is conducted on a regular basis to compare the outcomes and costs under the new model to national benchmarks.
Both of these oncology leaders have selected our Patient Engagement Portal as their technology solution to connect patients to their personal health records and communicate with their healthcare team. We look forward to supporting their efforts to offer a more patient centered approach to care as they explore new medical home care models.