The healthcare system is in the early stages of a transformation as the patient centered care concept gains more traction. Buzzwords such as Accountable Care Organizations (ACO’s) and Medical Home are being used to describe the future of healthcare delivery, yet how those terms translate into an actual care model is still being defined. Ultimately, the goal is to deliver better quality care in a more efficient manner, which will benefit patients, providers and payers.
Value Based Agenda
The patient centered medical home (PCMH) concept is an attempt to address the fragmented delivery of care by promoting a value-based agenda. Two cornerstones for increasing value in cancer care are standardizing processes so every patient receives the most appropriate care, and managing treatment side effects to reduce emergency department visits and inpatient care.
The assertion is that payers would pay physicians for providing the services that keep patients out of the emergency department and hospital, thereby reducing their total health care costs significantly.
Oncology Patient Centered Medical Home Example
Consultants in Medical Oncology and Hematology (CMOH), a community oncology practice in suburban Philadelphia lead by Dr. John Sprandio, is the first oncology clinic in the country to be recognized as a level 3 medical home, the highest designation possible. CMOH has been featured in Oncology Times and Community Oncology as an example of how oncology clinics can put the patient centered medical home concept into practical use.
To apply the PCMH model to oncology, Dr. Sprandio focused on the following aspects of care delivery:
- Streamline and standardize the process of patient evaluation in the medical oncology office.
- Coordinate all aspects of cancer related evaluations and services beyond the medical oncology office via patient navigators.
- Proactively promote an interdisciplinary approach to management.
- Constantly collaborate between the clinical support and treatment teams.
- Stress the importance of patient education, engagement and compliance.
- Enhance patient access to allow proactive management of symptoms via extended hours, telephone triage services, and physicians on–call.
- Minimize clinically irrelevant physician activity.
- Fix accountability for care delivery at the physician-patient locus.
- Assume ownership of cancer related needs in a highly personalized way.
Oncology Patient Medical Home Results
CMOH offers many value-based services that increase their costs, but they also have the data that shows this approach improves outcomes and is more efficient.
In Community Oncology, Dr. Sprandio outlined in depth how his practice applied the PCMH model to cancer care, and their results.
- Since 2005, CMOH has increased the number of patients treated by 29% with the same number of physicians and a decrease in office staff.
- In 2009, CMOH had a 16% reduction in ER admissions, and another 10% drop in 2010.
- The number of incoming clinic calls resulting in an ER referral dropped by more than 50% over a 5-year period.
Notably, all the advancements the practice has made since adopting the PCMH model they have attributed to their health IT systems and a culture of continuous process improvement. The following quote is from Dr. Sprandio via the Oncology Times article.
“You really have no idea how you are performing as a practice until you start measuring,” Dr. Sprandio said. “Only then can you go back and improve your processes of care and thus your performance.”
Also of note, as of February 2011, only one private payer was paying the practice for their enhanced services.
Patient Centered Medical Home Standards
The National Committee for Quality Assurance (NCQA) is a non-profit organization that accredits and certifies practices as patient centered medical homes (PCMH). In January 2011 they released their updated criteria for certification, a set of nine standards. To achieve the highest level of recognition (Level 3), all nine must be met. The standards in bold are criteria that are addressed in the Meaningful Use stages.
- Increased patient access and enhanced communication.
- Patient tracking and registry functions, including reminders for preventative screenings.
- Care management and adherence to nationally accepted, evidence-based standards of treatment.
- Patient self-management and support to avoid potential complications of treatment and disease.
- Electronic prescribing and physician ordering.
- Test tracking and monitoring patient compliance.
- Referral tracking.
- Continual performance reporting and improvement.
- Advanced electronic communications including a portal for patients and referring physicians.