Credit: UPMC Hillman Cancer Center
The Oncology Care Model is an initiative of the Centers for Medicare and Medicaid Services to improve the value of patient care by ensuring high-quality and more coordinated patient care while lowering the cost of care to Medicare.
CMS provides financial incentives to oncology practices to enhance care coordination, patient navigation and utilization of treatment guidelines for patients undergoing chemotherapy.
Payment to practices is in two parts, with the first being a Monthly Enhanced Oncology Services payment, which is a monthly payment to help practices with patient care coordination and reduce the cost of care. The second payment is a performance-based payment, which practices receive if they achieve a lower cost of care through care coordination and improved patient care.
Oncology Hematology Associates in Pittsburgh, part of the UPMC Hillman Cancer Center, is one of only 192 physician practices selected to participate in this program.
"We strive to ensure that each patient is treated in the appropriate clinical setting," said Rushir Choksi, MD, an oncologist at UPMC Hillman Cancer Center.
"We are establishing an oncology emergency room at UPMC Shadyside Hospital where our cancer patients can be seen and cared for by oncology trained providers," he added. "When they present to the emergency room, the patients will be triaged to the appropriate clinical setting and decisions will be made to either admit to the hospital, treat in an outpatient setting and/or follow closely at home."
In the outpatient clinic, the provider has implemented other initiatives. It works with Via Oncology and uses provider-facing pathways for chemotherapy treatment decisions.
The Via Oncology tool – which just this past month was acquired by Elsevier – was developed at UPMC several years ago and it provides web-based standardization of treatment decisions, so that no matter where a patient is seen, his or her doctor knows the best standards of care.
The pathway for each disease site is updated quarterly. If there are competing therapies that are equal in efficacy and toxicity, then the system will default to the least costly. Another initiative is a nurse triage program, which provides a nurse-facing patient triage platform to standardize symptom management when a patient calls the office. This was also developed by Via Oncology and, again, standardizes symptom management, regardless of clinic location or nurse.
On another front, UPMC Hillman Cancer Center uses technology from Integra Connect, a specialty care health IT vendor, that has supported the center's success to date in value-based care in multiple ways.
"It provides a platform for unifying our disparate data – such as EHR, practice management, claims and pathways – and helps us develop a more holistic view of the patients we treat, on both a population and individual level," Choksi explained.
The technology also provides the cancer center with population health analytics so it can identify the highest-impact opportunities to further improve quality and cost in alignment with value-based care requirements.
"This is especially important for our successful participation in the Oncology Care Model program," Choksi said. "For example, Integra Connect analytics help us understand our patients' incidence of inpatient admissions, ER visits and hospice care – the three most powerful levers for managing cost of care. We are able to analyze usage by cancer type, by provider, by location, at an individual level and more."
The market for population health analytics tools is a strong one, filled with technology companies offering varying systems. Players in the space include The Advisory Board, Caradigm, IBM Watson Health, Evolent Valence, Linguamatics, Optum, Philips Wellcentive and ZeOmega.
The cancer center also is able to benchmark against peers. That way, it can better target its efforts to engage with patients and help them get the most appropriate care, he added. In addition, the center works with the technology vendor to report performance on value-based care measures to CMS.
Results to date have been positive. The most important result is that the technology has provided the center's care teams with unprecedented levels of visibility to understand their patient populations, and it has enhanced their ability to target appropriate interventions.
"We expect to see that translate into improvements in outcomes and cost of care as our value-based care efforts continue to progress," Choksi said.
Another result has been that the center successfully submitted all the required quality reporting for the Oncology Care Model without having to mine and analyze the data itself; and the center will see this repeated with each subsequent semi-annual Oncology Care Model quality reporting deadline, Choksi said.
"We are in the process of doing the same for the Merit-based Incentive Payment System," Choksi added.