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Inside Look: First Oncology Medical Home

Butcher, Lola

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The excitement over the oncology medical home can be drilled down to three simple statistics from one of the first functioning oncology medical homes:

* A 65 percent decrease in emergency department visits per chemotherapy patient between 2006 and 2011.

* A 51 percent decline in the rate of hospital admissions per chemotherapy patient between 2007 and 2011.

* A 21 percent decline in length of stay for patients admitted to the hospital between 2008 and 2011.

That is what happened when Consultants in Medical Oncology and Hematology (CMOH), a practice in southeastern Pennsylvania, adopted the medical home model. And that is why every insurer in America is salivating for more oncology medical homes.

Although cancer patients under active treatment represent only about one percent of the typical payer's patients, the cost of caring for them accounts for nearly 10 percent of an insurer's annual outlay.

Insurers have traditionally tried to contain costs by focusing on drug utilization, but their attention is turning to hospitalization and ED use as another source of big savings potential. Indeed, Ira Klein, MD, Senior Medical Director for Aetna, says hospital costs for cancer patients nearly equal drug costs.

Trying to reduce drug costs is often controversial because physicians and patients worry that insurers are more concerned with money than patient health. But keeping patients out of the hospital is a goal everybody shares.

“The savings accrued are aligned with patient interests in that patients have a reduced need for very expensive components of the healthcare delivery system: the ER and the hospital,” said John Sprandio, MD, CMOH's lead physician. “That's the major lever here that is capturing so much attention.”

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What First Means

In addition to being the first oncology practice to embrace the medical home concept, CMOH is the first—and possibly the only—oncology practice to be recognized as a Level III patient-centered medical home (PCMH) by the National Committee for Quality Assurance (NCQA.)

CMOH received the designation after it met the nine criteria NCQA requires for primary care practices seeking its highest level of recognition. Subsequently, however, NCQA said it does not plan to extend the PCMH imprimatur to other specialty practices.

Sprandio describes CMOH as an “oncology patient-centered medical home” (OPCMH) and, in fact, he has trademarked that term.

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The Contract of your Future?

Sprandio began transforming his practice to a medical home in 2004 (OT, 2/25/11). Until this year, however, only one payer—a Medicaid HMO—has paid CMOH for the extra services it is providing.

“We really do think that this model fixes cancer care delivery, so we have, in effect, put forth a model for cancer care delivery reform,” he said. “What we are doing now is trying to develop a model for payer reform to match it.”

CMOH last year created a new consulting company, Oncology Management Services (OMS), which employs contracting specialists with extensive experience in cancer care. For the past several months, OMS has been working with a national payer and regional payer to develop medical home contracts for CMOH.

That contract framework, however, may be used far beyond his practice. The template that OMS has helped to develop includes the core tenets of the OPCMH, and Sprandio said he expects that the national insurer he is working with will offer the contract to oncology practices throughout its network.

“What they are hoping to do is to take this model to different areas of the country and then have some of the more dominant regional payers partner with them so that they are not the only ones providing the additional support for the medical oncologists,” he said.

The “additional support” he refers to is an insurer's financial commitment to help sustain an oncology practice as it transitions from buy-and-bill to medical home. The transformation involves changes in staffing patterns, workflow, patient interaction, office hours, and data capture and analysis, all of which are disruptive to normal operations.

In addition to upfront support, medical home contracts must identify how a practice's performance will be measured, since part of its pay will be based on performance. This requires agreeing on the performance measures that will be used and how they will be validated. Additionally, CMOH wanted its performance to be compared with his market at large, rather than to its own performance in previous years, and that requires time-consuming data collection and analysis.

“It's a major, major undertaking,” Sprandio said. “A lot of the conversations centered around payers' ability to verify our data. We needed to look at the whole cost of care, from the time we are brought into the case through completion of therapy and survivorship.”

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iPad Exclusive!
Podcast: Oncology Practices Expect Big Change

A new survey by the Association of Community Cancer Centers finds that the majority of respondents expect they will be practicing as an oncology medical home or part of an accountable care organization within five years.

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Most respondents think the medical home model will work for oncology care—but many are worried about the transition from their current practice to the care delivery model of the future.

Listen on the iPad edition of this issue to ACCC Immediate Past President Thomas L. Whittaker, MD, discuss the survey results.

Thomas L. Whittaker,...
Thomas L. Whittaker,...
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© 2012 Lippincott Williams & Wilkins, Inc.

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