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Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending

Colligan, Erin M. PhD, MPP*; Ewald, Erin ScM; Keating, Nancy L. MD, MPH‡,§; Parashuram, Shriram PhD; Spafford, Michelle MIA; Ruiz, Sarah PhD; Moiduddin, Adil MPP

doi: 10.1097/MLR.0000000000000795
Original Article

Background: Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly.

Objective: We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending.

Methods: Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models.

Results: In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P<0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P<0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P<0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P<0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P<0.05), than comparison patients.

Conclusions: The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.

*Centers for Medicare and Medicaid Services, Baltimore

NORC at the University of Chicago, Bethesda, MD

Department of Health Care Policy, Harvard Medical School

§Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA

Administration for Community Living, Washington, DC

This work was completed while she was at NORC at the University of Chicago. Supported by Centers for Medicare and Medicaid Services contract to NORC at the University of Chicago, Contract #HHSM-500-2011-00002I Task Order #HHSM-500-T0009.

The statements contained herein are those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services.

The authors declare no conflict of interest.

Reprints: Erin M. Colligan, PhD, MPP, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mail Stop WB-06-05, Baltimore, MD 21244. E-mail: erin.colligan@cms.hhs.gov.

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