Patient-Centered Oncology Medical Home in New Mexico Demonstrating Value
Hollywood, FL— A community oncology medical home headed by Barbara L. McAneny, MD, Chief Executive Officer and Managing Partner of the New Mexico Cancer Center, Albuquerque, is a good example of how putting patients first can be good for patient care and good for the bottom line.
Dr McAneny received a $20-million Centers for Medicare & Medicaid Services Health Care Innovation Award to create a patient-centered medical home that encompasses 7 practices across several states. Innovative Oncology Business Solutions is the managing organization formed for the purpose of administering the project.
The first phase of the program is already showing promising results. “We proved there are significant savings from being an oncology medical home versus a hospital-based integrated system,” she said. “So far, my patients say they are thrilled with this. They write me thank you notes and bring flowers to the office.”
Some of the grant money will go to Net.Orange, which is a health information technology company that is creating customized quality and pathway performance dashboards using claims data and integrated electronic health records. The KEWGroup will help the practice integrate genetic markers into diagnostic and treatment pathways.
The University of Tennessee is providing expertise in evaluation, cost, and quality measurements, and will be using claims data for rapid-cycle feedback of cost utilization performance. “This is where we get a health economist to manage the data,” Dr McAneny explained.
The COME HOME Model
Patients with newly diagnosed or relapsed cancer from these 7 sites will be put on diagnostic and therapeutic pathways. “We will be aggressively making sure we take care of these patients,” she emphasized.
Aggressive team-based patient management does not mean that all care is delivered by the oncologist, Dr McAneny said. “We will use all the members of this team to the peak of their licenses,” she said. “We don’t need nurse navigators; everyone in my practice is one. We need people interested in taking care of the patient.”
At the heart of this basic Community Oncology Medical Home (COME HOME) model (Figure) is team-based care that manages the side effects of cancer and its treatments aggressively, with the goal of keeping patients out of the emergency department and hospitals.
In phase 1 of the model, enhanced services include:
- Patient education and medication management
- 24/7 practice access: telephone triage, triage pathways, night and weekend clinic hours, and on-call physicians
- On-site or near-site imaging and laboratory testing
- Admitting physicians who shepherd patients through inpatient encounters, avoiding handoffs and readmissions, and ensuring seamless care.
The tumor types and estimated patient enrollment, by tumor type, include breast (N = 1891), lung (N = 1830), colorectal (N = 1058), lymphoma (N = 641), melanoma (N = 523), pancreas (N = 479), thyroid (N = 175), and others (N = 2961), making a total of almost 10,000 patients treated under the COME HOME model.
Diagnostic and treatment pathways are being developed for phases 2 and 3 of the model. Decision support will be provided for the proper use of genomics in the pathways.
“We will be able to manage all this, because all 7 of our practices must have medical records from which you can pull data in real time,” Dr McAneny said.
Enhanced access to care is part of the plan. This means providing 24/7 triage with “first responders” and on-call providers. The practice is open until 6 pm and on weekends. “Most practices are set up for the convenience of the doctor. Ours is set up for the convenience of the patient,” she noted. “When a patient calls in and says she is sick, our answer is, ‘Come in at 2 pm.’ Everyone in the office has to be of the mindset that their job is to solve the patient’s problem. Patients know that if they get sick, we are here for them,” Dr McAneny emphasized.
“My practice is the only one with extended hours so far, but others are rolling out soon. In my practice in New Mexico, for our first 3 months with extended hours, we kept 92 patients out of the emergency department,” Dr McAneny reported.
In this model, the oncologists directly admit patients and do not refer to hospitalists or emergency departments. “We believe that when our patients get sick, they want their own doctor, not someone else’s.”
Part of the group’s mission is to prove that their care is as good as, or better than, care received anywhere, and that the care is provided at a lower cost. To demonstrate this, the practice intends to prove that providers can follow pathways, prescribe appropriately, and produce good or equivalent outcomes that can be measured in meaningful ways.
Data Management Is Key
All of the practices are fully electronic, allowing for data extraction and outcomes measurements. Dr McAneny and colleagues will compare their data with Medicare claims data to determine savings. They would like to use the National Comprehensive Cancer Network member institutions as the gold standard for optimal care and for comparison of outcomes. The projected savings are already known to be substantial, she said, as shown in the Table.
“We are expected to save about $4000 per patient episode, significantly more than the $7 per patient that has been shown for hospital-based groups,” she said. “We think we can go to bundled payments, but transparency is essential. We need to know what we are keeping and why.”