Oncology Medical Home Accreditation by Community Oncology Alliance Making Progress

Wayne Kuznar

September 2015, Vol 6, No 8 - AVBCC 2015 5th Annual Conference


Washington, DC—The Community Oncology Alliance (COA) is in the midst of developing an oncology medical home program. Ten oncology practices have participated in COA’s pilot program (Table), and the oncology medical home model will be expanding to 50 more practices during 2016.

Table

At the Fifth Annual Conference of the Association for Value-Based Cancer Care, Bo Gamble, Director of Strategic Practice Initiatives at COA, shared the goals, structure, eligibility criteria, and quality measures used in COA’s pilot initiative to accredit oncology practices as oncology medical homes.

The development of an accreditation program began in July 2013, involving the American Society of Clinical Oncology, COA, the Commission on Cancer, the National Comprehensive Cancer Network, and the COME HOME oncology medical home project.

The accreditation of oncology medical homes focuses on alignment with community oncology practices’ priorities. “We’re focusing on quality, outcomes, value, and most important,…proof that good things are being done,” said Mr Gamble. “This was a very laborious, sometimes anxious moment trying to work through some of the details that we needed to put in this program, but it’s very exciting.”

To date, the accreditation process of the Commission on Cancer has focused on quality.

The key to COA’s oncology medical home program is value, Mr Gamble emphasized.

At this point, COA’s draft of the standards manual has been completed, and the 10 pilot practices have been educated on the standards. The onsite oncology medical home accreditation visits have been completed. The proposed standards include the following 5 domains:

  1. Patient engagement
  2. Expanded access
  3. Evidence-based medicine
  4. Comprehensive team-based care
  5. Quality improvement.
Patient engagement proposals include documented procedures for financial counseling, patient orientation and education, and a patient portal that is available or is under development. A proposed objective validation is the percentage of patients who receive a treatment plan before the initiation of chemotherapy. Survivorship plans and end-of-life plans are other measures that are specific to patient communication, said Mr Gamble.

The expanded access standard requires easy access to the oncology medical home and its providers by new and established patients, including the availability to schedule same-day appointments for patients requiring urgent care. Another proposal is that at least 1 oncologist should be on call overnight to manage emergencies. “You’ve got to make sure that your patients have access to you all hours, after hours, and on weekends,” Mr Gamble said.

The documented use of treatment guidelines and evidence-based appropriate resource utilization are standards contained in the evidence-based medicine domain, which will be validated by measures such as the percentage of patients treated according to guidelines and the percentage receiving appropriate advanced imaging. Another standard under this domain is that clinical trials are offered through the oncology medical home.

Comprehensive team-based care would incorporate hospitalists and/or primary care physicians as comanagers of the patient, together with an oncologist, to ensure that comorbid conditions and side effects are managed adequately.

The process standards for quality improvement include the institution of a certified electronic health record, documentation standards, and patient satisfaction surveys.

“Measure, measure, measure,” is the COA mantra, said Mr Gamble. “We’re no longer in that situation where it’s believable…when you just describe it. You’re at a point that now you’ve got to show it,” he said.

“I can’t tell you that this is a perfect program, but I can tell you that it aligns; it makes sense,” Mr Gamble said.

Suggestions and advice have been received from the pilots on how to improve the accreditation effort.

In the end, the standards and accreditation program must be meaningful and must truly effect change in the practices, said Mr Gamble. “We’re not here to add burden in any shape, form, or fashion, administrative or financial,” he said. “We’re just here to help you make that transition.”

The next steps are to finalize the standards, optimize the survey process, develop a business plan to ensure that the program is self-sustaining, and engage payers to assess how the oncology medical home accreditation can be meaningful to them.