November 2012 Edition Vol.11, Issue 11

Pilot Phase of Michigan Oncology Medical Home Demonstration Project Launches: Patient Satisfaction Increases, Future Phases Planned

Pilot Phase of Michigan Oncology Medical Home Demonstration Project Launches. Patient Satisfaction Increases, Future Phases Planned.

By Mark Johnson, John Fox, MD, & Jane Tozer

As the debate over healthcare reform continues, our industry is focused on developing new and better models of care to help improve outcomes and control the cost of healthcare. Recently, we have witnessed public concern over the perceived high costs of cancer therapy. Medical expenditures for cancer care are projected to reach at least $158 billion in 2020, according to an analysis completed by the National Institutes of Health, though the rate of increase has leveled, and is in line with both the growth and aging of the U.S. population. Regardless, the links between costs, outcomes, quality measures and value remain critical, and will continue to be scrutinized.

As a result, we have seen oncology medical homes created to address public concern over the cost of cancer therapy, while supporting appropriate compensation to community oncologists for the breadth of services necessary to deliver quality care. Traditionally, the patient-centered medical home concept is a physician-led, multi-specialty care team approach developed for primary care practices as a way to integrate care across multiple disciplines and control costs. The concept of medical home for community oncology, however, intuitively makes sense, as oncologists most often become the epicenter of their patients’ care. While these patients may still see other specialists such as a cardiologist during their cancer treatment, the oncologist orchestrates those efforts for the patients and ultimately, serves as the primary source of care. Multiple studies have shown the community setting to be the most efficient and cost-effective site of care for oncology patients. Oftentimes, though, as the reimbursement for injectable drugs decreases, and overhead increases, community oncologists struggle to remain viable. 

As a potential solution, Priority Health, a leading payer in Michigan, in partnership with Physician Resource Management (PRM), recently launched the Michigan Oncology Medical Home Demonstration Project. ION Solutions was selected as the preferred partner for the pilot program. The project is working to address overall oncology costs by implementing an integrated approach to patient care and utilizing evidence-based treatments. This approach aims to improve the management of side effects and lower costs through reduced hospitalizations and emergency room visits. 

This particular demonstration project strives to create value for its three main constituents: patients, providers, and payers. 

  • For patients, we are working to provide better care in a more convenient setting, increase time on therapy by reducing side effects, and decrease hospitalizations. 
  • The goal for providers is to provide a sustainable financial model, which will allow them to continue to deliver care in a private, autonomous setting. 
  • And through improved transparency, we are enabling payers to document the benefits to their patients so that as overall cost curves improve, they can translate the results to their value proposition.

PRM initially identified three active practices in the southeastern Michigan area, which participate in the Priority Health network, for the pilot project. These 20 physicians comprise phase one of the Michigan Oncology Medical Home Demonstration Project. PRM recruited an additional practice with practice of nine oncologists, which joined the pilot at the beginning of November. All of the practices have committed to working to improve the process of delivering care so that community oncology remains a viable option for patients. 

Each practice is implementing technology, tools, and services to advance the clinical decision-making capabilities of oncologists and highlight how quality care is delivered to patients. “The physicians are finally integrating into their patient flow the quality priorities they have long talked about,” said Tracy H. Messing, Office Manager, Hematology Oncology Consultants PC in Royal Oak, Michigan, one of the participating practices. Hematology Oncology Consultants PC has recorded 100 percent compliance to National Evidence-Based Guidelines from May through September. In addition, each practice is asked to standardize treatment to a single regimen per cancer type/line of therapy – for example, high-risk adjuvant breast cancer or first-line metastatic breast cancer – and Hematology Oncology Consultants PC has 100 percent compliance to their preferred regimens as well.  

ION Solutions serves as the technology, integration, informatics and analytics partner by collecting, aggregating and measuring data and information generated by participating practices. ION Solutions’ provider and payer reporting portal allows both stakeholders to receive program updates, including current and historical compliance and program reports on a monthly basis detailing compliance for oral and injectable/infusible drugs with nationally recognized and practice-specific guidelines. Annual reports of guidelines compliance—as well as cost comparisons against benchmark—will be available after an analysis period following the anniversary date of the program launch. In addition, ION Solutions is utilizing its Nucleus Data Exchange, a proprietary tool that serves to connect disparate systems within each practice.

Priority Health has been exploring numerous options from pathways and medical homes, to studying how oncology care decisions are made, in an effort to show that the rising costs of oncology care can be slowed. The payment model designed with physicians includes reimbursement at cost for drugs; a flat monthly case management fee; an annual infrastructure development payment; expanded payments for treatment and advanced care planning; and shared savings for reduction of avoidable ER visits and hospitalizations. The pilot program considered historical claims data from Priority to decouple drug selection from drug margins. PRM represents the oncologists and their professional colleagues and gained their agreement with the pricing structure and the case management fee paid for all chemotherapy patients in active treatment, including patients receiving oral compounds.

The drug reimbursement methodology levels the playing field for oncology drugs and enables the physician to make decisions based on patient imperative. Not only does this allow for the best treatment decisions based on professional expertise, it better acknowledges management services that are not adequately recognized in the current system. Each year, the practices that have reduced hospital and emergency room costs and improved quality based on the benchmarks set according to historical claims data for the market will receive shared savings. 

Another key component of this initiative is Navigating Cancer’s Patient Engagement Portal, which is available to assist practices in establishing a more patient-centered focus, while inviting the patient to take a more active role in their care. This patient interaction is a critical element of the medical home. 

ION Solutions is providing additional resources for the pilot program, including: 

  • Advance Care Planning Program, which utilizes Aging with Dignity’s Five Wishes packets to help outline end of life care;
  • Symptom Management Program, adapted from the Oncology Nursing Society, which provides guidelines for standardization of nurse phone triage and tracks recommendations made to the patient; and
  • Pegasus’ compliance reporting, which helps track use of evidence-based care decisions for optimal patient care.

The initial results of the Michigan pilot are positive—all three practices are tracking compliance to national guidelines and are 100 percent compliant for May through September, plus all are 100 percent compliant to their practice-specific guidelines. While limited quantitative data is available about the pilot program at this time, the stakeholders have received qualitative feedback from patients and staff. All four active practices have begun conducting advance care planning visits and have received good responses about the program. They have also begun symptom management which has increased efficiencies and standardization for the nursing staff.

Future phases are being planned for a 2013 start date. It is still too early to determine the cost savings for this particular project – and for medical homes overall. By design, however, this model seeks to align the interests of all stakeholders. By offering physicians adequate reimbursement for patient management, rather than drug selection, physicians are able to make clinical decisions based upon quality care, thus improving overall results and reducing hospitalizations and emergency room visits. 

PRM, Priority Health and ION Solutions are continuing to recruit community oncology practices that are interested in participating in future phases of the Michigan Oncology Medical Home Demonstration Project and remain committed to refining various models of care to achieve improved outcomes and greater value, while supporting the viability of community-based oncologists.

About the Contributors

Mark Johnson is President of ION Solutions, a business unit of AmerisourceBergen Specialty Group and the country's largest physician services company for the community oncology market. Mr. Johnson brings more than 30 years of managed care and specialty healthcare experience to this position and holds a Master of Health Administration (MHA) degree and a Bachelor of Science (BS) degree, both from Duke University.

John Fox is Associate Vice President, Medical Affairs at Priority Health. He is responsible for medical technology assessment, utilization and case management, physician profiling and pay-for-performance programs. Mr. Fox has a medical degree from Johns Hopkins University, as well as a Master of Science from the University of Wisconsin and a Bachelor of Science from the University of Illinois.

Jane Tozer is the Director of Business Operations and Clinical Pathways for Physician Resource Management, a healthcare and physician consulting firm that specializes in improving the efficiency and success of oncology practices.  Ms. Tozer has over 25 years of experience in healthcare administration.  As the Director of Business Operations, Ms. Tozer plans, directs, and coordinate the operations of PRM and manages the payer initiatives, including the Michigan Oncology Clinical Treatment Pathways Program.  She has a Bachelor of Science (BS) degree in Health Administration from Eastern Michigan University.

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