The oncology community has experienced dramatic marketplace consolidation over the last several years. For some physician practices this consolidation has given rise to new partnerships with hospitals and health systems; while for others it has meant outright purchase by a hospital or health system. Still, many physician practices have embraced the transition from fee-for-service to value-based care, experiencing great success under alternative payment models, such as the Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM).
Learn from three of these forward-thinking practices during a panel session, “Physician Practice Models That Succeed in a Value-Based World,” at the 2018 ACCC Annual Meeting and Cancer Center Business Summit, March 15-16, Washington, DC.
Alliance Cancer Specialists, the largest community oncology practice in southeastern Pennsylvania with 21 oncologists in 11 locations, began a population health management journey in 2016. The practice realized that improving outcomes and reducing costs for cancer care episodes required a comprehensive understanding of each patient’s entire healthcare experience. To manage outcomes reliably, Alliance also needed to understand care delivered outside the network (tests, procedures, specialty providers, etc.), home care and long-term care services, and prescription fulfillment activities, to name a just a few. Finally, to drive fully informed decision-making, Alliance physicians required a thorough understanding of co-morbid conditions and other encounters (e.g., a recent foot or bladder infection) that patients may not have mentioned to their oncologist, believing them to be irrelevant.
Without comprehensive data, Alliance Cancer Specialists found it challenging to make holistic decisions about care, and to identify high-risk patients who may require more intensive management throughout their treatment. The practice also struggled to compare quality and cost variation that respected the severity of illness across a physician’s patient panel.
By integrating claims and pharmacy fulfillment data with the information in its electronic health record (EHR) Alliance Cancer Specialists was able to create a complete longitudinal record for each patient and analyze data to identify gaps in care, which helped its team drive individualized care planning activity. And most importantly, these data were available on one centralized platform with an easy-to-navigate dashboard display.
Further, by implementing a population health management platform to support its efforts around the OCM, a value-based care delivery process is emerging at Alliance Cancer Specialists. The practice can now identify patients by stage, highest clinical risk, most frequent use of ER and hospital resources, and prescription fulfillment activity—even patients with high-cost care for non-cancer co-morbidities.
“Breaking down the walls between the EHRs, health information exchanges, and hospitals and lab systems has provided a comprehensive picture of individual patient care,” shares Ann Marie Edwards, CEO, Alliance Cancer Specialists. “Risk stratification within the patient population has helped us focus attention and resources appropriately. Further, our connection to the health information exchanges provides daily notification of admissions, discharges, and ER visits so that we can better manage transitions of care.”
Alliance Cancer Specialists now ensures that the sickest patients garner greater attention from care navigators and clinical staff, are seen more often in the office, and receive coaching on symptom reporting and management.
“Every practice has to choose a starting point to embark on the journey to value-based care and for us it has been using patient-centric analytics to bring an individual’s needs into focus and to streamline efforts in the most meaningful way,” Edwards continues. “It is a journey and we are early along the path to having these actionable analytics to inform care decisions but aligning value and quality is finally well within our reach.”
Florida Cancer Specialists, the largest independent hematology and medical oncology practice in the U.S., with more than 200 physicians, 160 nurse practitioners and physician assistants, across nearly 100 locations is also participating in the OCM and other innovative payer partnerships to develop and implement new care delivery models.
“The advent of the Oncology Care Model, as well as shared-savings contracts, has significantly increased the accountability placed on community-based oncologists to control ever-increasing costs of providing cancer care while simultaneously improving the quality of care provided to cancer patients,” explains Brad Prechtl, MBA, CEO, Florida Cancer Specialists. “As a result of this focus on cost and quality, practices have had to transform themselves from the traditional fee-for-service mentality, to being able to coordinate and oversee the entire continuum of care for a cancer patient, while at the same time documenting quality standards effectively and efficiently.”
During this session, Prechtl will share real-world strategies to help other practices thrive—and not just survive—their own transition to value-based care.
Rounding out the panel will be James Wade III, MD, FACP, who will talk about the successes and lessons learned at Cancer Care Specialists Central Illinois, SC, from their participation in the OCM.
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