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NCQA Plans Patient-Centered Oncology Demonstration

Butcher, Lola

doi: 10.1097/01.COT.0000424098.08123.ab


Consultants in Medical Oncology and Hematology (CMOH), a nine-physician practice in southeastern Pennsylvania, is the only oncology practice to be recognized as a Level III patient-centered medical home by the National Committee of Quality Assurance, one of the key organizations for advancing the medical home model of care in America.

In January, NCQA will launch a demonstration project to see whether the outcomes achieved by that practice—including among others, reduced hospitalization rates, fewer emergency department visits, and less chemotherapy near the end of life—can be replicated by other oncology practices.

“We want to expand the model and verify it beyond our practice in a rigorous and scientific way to prove the value of this,” said John Sprandio, MD, CMOH's lead physician.

Practices that participate in the demonstration will be evaluated on oncology-specific standards—most likely based on the Quality Oncology Practice Initiative (QOPI) measures developed by the American Society for Clinical Oncology as well as outcome measures being developed by the Community Oncology Alliance.

The demonstration is important because it may usher in a new way for oncology practices to be paid. Across the country, many of the more than 4,000 NCQA-designated primary care patient-centered medical homes are being bolstered financially as payers reward them for delivering care in a way that improves patient outcomes while holding costs in check.

Sprandio noted that local payers in the southeastern Pennsylvania market are interested in supporting practices participating in NCQA's Patient-Centered Oncology Demonstration, and that the findings should be useful to help other payers know whether the model lives up to its promise.

“We want to know if payers would be willing to adjust their approach to payment to reward and encourage the kind of behaviors that we're looking for in these standards,” said NCQA's Vice President of Product Development, Patricia Barrett.

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Oncology Medical Home Initiatives

The term “medical home” is being applied to many oncology initiatives around the country as physicians and payers look for ways to stop or slow the spiraling costs of cancer care, provide optimal treatment to patients, and keep oncology practices from closing shop or selling to hospitals. Among them:

  • Barbara McAneny, MD, CEO of the New Mexico Cancer Center, received a Centers for Medicare and Medicaid Services grant for approximately $19 million to develop a medical home model for cancer patients in her state and six others.
  • Several U.S. Oncology practices, including Texas Oncology and Wilshire Oncology Medical Group in Los Angeles, are in medical home pilot contracts with various private payers. Meanwhile, Priority Health, a regional payer in Michigan, has signed medical home contracts with several oncology practices.
  • The Community Oncology Alliance has assembled a multidisciplinary steering committee to develop the medical home model for cancer care and an implementation team to operationalize the model (OT, 4/25/12). COA Executive Director Ted Okon said the work is progressing quickly so that oncology practices can start adopting the model early next year.

Okon says payers are more engaged in payment reform for oncology services than he has ever seen. “The amount of cooperation on this from the payer side is nothing short of remarkable,” he said.

Here is why payers are enthusiastic: CMOH estimates that its care delivery model is saving payers $1 million per physician per year (JOP 2012;8,3S:47–49). That savings comes from care coordination, proactive symptom management and other innovations that CMOH introduced as part of its conversion to the medical home model beginning in 2004 (OT, 2/25/11).

JOHN SPRANDIO, MD: “We want to expand the medical home model and verify it beyond our practice in a rigorous and scientific way to prove the value of this

JOHN SPRANDIO, MD: “We want to expand the medical home model and verify it beyond our practice in a rigorous and scientific way to prove the value of this

By changing the way the practice's clinicians care for their patients, it has seen hospital admissions drop by half and emergency department visits cut by two-thirds—along with shorter inpatient stays, fewer outpatient visits for chemotherapy patients, and decreased use of chemotherapy in the last 30 days of life.

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What NCQA is Doing

Shortly after NCQA recognized Consultants in Medical Oncology and Hematology as a Level III—i.e., the highest level—patient-centered medical home, the Committee decided to reserve the designation solely for primary care practices. Thus, that imprimatur is no longer available to other oncology or other specialty practices.

But NCQA has received so many inquiries from specialty and subspecialty practices wanting to jump on the medical-home bandwagon that it decided to develop a new specialty practice recognition program. Medical practices believe that, by earning official recognition for meeting the NCQA's quality and efficiency standards, they will convince payers of their increased value and that they should be paid more than their peers who have not done so.

Earlier this year, Sprandio approached NCQA about developing oncology-specific standards to advance the oncology medical home model. “We convinced them in the spring to make oncology a first priority because of the crisis in community oncology,” he said.

This fall NCQA convened an expert panel that included oncologists, payers, and representatives from COA and ASCO to discuss the demonstration project. Barrett said the Committee did not originally envision the use of specialty-specific standards to evaluate practices, but the oncology demonstration project will examine whether they add value.

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Trademarked Term

NCQA does not use the term “medical home” for specialty practices, but Sprandio does. Indeed, he trademarked the term “Oncology Patient-Centered Medical Home®” in response to the proliferation of definitions as to what constitutes an oncology medical home. And he formed a consulting firm to help other practices adopt the model CMOH uses.

“We really needed the NCQA to step up and develop a standard to protect the concept and to define what this is so that payers could have a standard model to build a methodology for changing the payment system.”

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Demonstration Details

NCQA is applying for grant funding that would help practices participating in the demonstration to re-engineer their practices and pay for an evaluation of the project. If that funding is obtained, Barrett expects the demonstration to launch in January. About 10 to 15 delivery sites in southeastern Pennsylvania will convert to the medical home model and their outcomes will be compared with those of a control group of similar size.

She said she expects it to be a three-year project, but preliminary data will be analyzed and put to use before the demonstration is completed. “Within a year of implementing the model, we think we will be able to get some data that will show us whether or not it's promising, whether it's looking somewhat like the Sprandio results,” she said.

If it is, the findings will be used to help develop the final standards of the NCQA's formal recognition program for patient-centered oncology practices.

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How to Earn Recognition

Separate from the demonstration project, NCQA expects to introduce its recognition program for all specialty medical practices in March. In developing its specialty recognition standards, NCQA is building off the standards it uses for the primary care patient-centered medical home.

The draft standards, which were made available for public comment last summer, include some 150 practice elements that fall into six buckets:

  • Provide Access and Communication
  • Identify and Coordinate Patient Populations
  • Track and Coordinate Referrals
  • Plan and Manage Care
  • Track and Coordinate Care
  • Measure and Improve Performance

The NCQA scores practices based on the number of elements they have attained. In its primary care patient-centered medical home program, certain elements—for example, active support of patient self-management and measurement of clinical and/or service performance—are “must-haves” for practices that want the top recognition level, regardless of their overall score.

© 2012 Lippincott Williams & Wilkins, Inc.
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