July 2016 marked the start of oncologists looking at a new way to manage cancer care with a shift from fee-for-service to value-based care, prompted by the launch of the Oncology Care Model (OCM) by the Center for Medicaid & Medicare Innovation (CMS Innovation Center). Today, CMS Innovation Center is expanding on this foundation with Oncology Care First (OCF)—a next-generation model that will phase out OCM and further emphasize the benefits of adopting value-based care models that favor care quality and outcomes over quantity of services provided.
Thanks to the success of OCM and other programs, the adoption of value-based care is advancing rapidly, delivering improvements in collaboration, costs and quality that oncology should embrace sooner rather than later.
Collaboration is one of the most critical components of value-based care. Enhanced coordination of care among healthcare providers can help improve patient outcomes and lower costs by decreasing unnecessary hospitalizations and eliminating emergency room visits.
Routine interdisciplinary care team meetings allow for enhanced collaboration and communication among members to ensure a patient’s needs are being met and timely follow-up is in place. This team-based approach assures the entire care team is focused on the same goals of care for each individual patient.
Because value-based care is still relatively new, it is important to discuss with clinical and non-clinical team members the specifics of the model and the importance of collaboration, as well as how it benefits the patient.
Driving Down Costs
There are typically three main cost drivers facing oncology practices: hospitalizations, chemotherapy agents and variable resources. Driving down the costs associated with these drivers, while still providing top-shelf care, is essential to a successful transition to value-based care.
Education is a key component to effective implementation, and the primary focus in this case is the patient. Helping patients understand which symptoms of chemotherapy treatment merit a trip to the emergency room vs. an office visit with their oncologist or primary care physician can decrease unnecessary and costly ER visits. Strategies such as a “Call Us 1st” campaign can be an effective method to encourage patients to call their oncologist or physician first to see which route is better, assuming the situation isn’t life-threatening.
An effective triage system with nurses conducting proactive outreach to high-risk patients is another strategy that can deter the need for higher-cost interventions. Along those same lines, ensuring patients can always reach a live person by phone rather than having to leave a message—then worry about a call back—can also decrease costs associated with unnecessary emergency care.
Other cost containment resources include:
- Social workers, who can provide oncology patients and their loved ones with invaluable support throughout their cancer care.
- Nurse navigators, who guide patients and their families throughout the entire oncology care journey.
- Dietitians, who can educate patients on proper nutrition to lessen the side effects of treatment and improve recovery.
- Pathway adherence and evidence-based treatment options, such as the National Comprehensive Care Network (NCCN), which can help physicians and pharmacists identify less expensive, but still highly effective, drugs and treatment.
The Role of Data
As important as collaboration and cost containment measures are to the success of a value-based care model, they cannot happen without a solid foundation of data. For example, participating in state health information exchange initiatives carries unique benefits in the value-based care environment, such as the ability to connect with laboratories to access test results in real-time or being able to see when or if a patient was admitted to or discharged from the hospital.
Comprehensive patient data allows oncologists to better evaluate treatment outcomes and determine what, if any, changes could be made to prevent ER visits or admissions. It can even provide the basis for deployment of advanced communications such as texting medication and appointment reminders.
The data challenge is two-fold: it requires the right technological foundation and the understanding of data and how to use it in practice transformation efforts.
To overcome these challenges, the American Oncology Network (AON) built a Value Based Care team that collaborates with physician champions to review data and make recommendations for continuous process improvements. The development of a quality care committee consisting of representatives from various departments who are champions of the value-based care model has also proven to be effective. This committee of peers can demonstrate the value of data in reducing costs while improving outcomes.
Partnering with a Network
Transitioning to a value-based care model can be difficult and requires a level of infrastructure and manpower that many independent practices do not have—limitations that have forced some practices to pull back from its adoption.
However, partnering with a network such as AON can empower practices to embrace the potential of OCF. AON can provide the support and resources that set the stage for success in a value-based care environment. Among these are the technology and expertise to not only capture and share robust patient data, but also help transform hard-to-read metrics into action items.
A Proven Approach
While the model itself is relatively new to oncology, value-based care has already proven its effectiveness at improving patient care and driving down costs.
Value-based care isn’t going away. The sooner oncology practices embrace it, the sooner they will realize the many benefits it can deliver.