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Oncology Medical Home Update

Oncology Medical Home Update. Michael Diaz, MD COA Payment Reform Task Force COA Secretary. OMH Steering Committee. Why the Oncology Medical Home?. Best Outcomes Focus is first on the stakeholders Meeting the needs of patients, payers, and providers in cancer care

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Oncology Medical Home Update

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  1. Oncology Medical Home Update Michael Diaz, MD COA Payment Reform Task Force COA Secretary

  2. OMH Steering Committee

  3. Why the Oncology Medical Home? • Best Outcomes • Focus is first on the stakeholders • Meeting the needs of patients, payers, and providers in cancer care • Meeting their needs requires: • Improving the patient experience • Providing better value for the healthcare dollar • Keeping expert cancer care close to the patients’ homes • Measures of quality and value specific to cancer care • Includes patient satisfaction/experience • 19 measures that cover diagnosis to survivorship to death

  4. Three Stakeholder Needs of an OMH • Best Outcomes • Best possible survivorship and ability to be productive • Fewest toxicities and hospitalizations • Safety of therapy • Satisfied patients/members and families

  5. Processes of care • Best Practices – Medical Oncology, Radiation Oncology, Radiology, supportive care guidelines • Appropriate use of Genomics • Oral Compliance • Proactive patient management • Structured triage • Efficient use of resources – ER/Hospitals • End of Life Care

  6. CoC OMH IT Advisory Team Purpose – To develop and promote the intermediate and long term definitions to submit (electronically) quality, value and outcomes data to support the Oncology Medical Home accreditation program. IT Advisory Team

  7. IT Advisory Team Representation

  8. OMH MEASURES Patient Care Resource Utilization End of Life Survivorship

  9. OMH measures PATIENT CARE • % of patients with pathology staging pre-chemotherapy • % of patients that receive a treatment plan pre-chemotherapy • % of chemotherapy treatments that are adherent to NCCN guidelines • Antiemetic appropriateness • % of patients receiving GCSF with > 20 % risk of febrile neutropenia • Presence of performance status before a new line of treatment

  10. OMH Measures RESOURCE UTILIZATION • # of Emergency Room visits/patient/year • # of hospital admissions/patient/year • % of early stage breast cancer patients that received advanced diagnostic imaging • % of early stage prostate cancer patients that receive advanced diagnostic imaging

  11. OMH Measures END of LIFE • % of Stage IV patients with end of life discussions documented • Average # of days in hospice • # of deaths in the acute care setting • Days from last chemotherapy until date of death

  12. OMH Measures SURVIVORSHIP • % of patients receiving a survivorship plan < 45 days post chemotherapy • % of patients receiving psycho/social screening and interventions • Survival rate of colon, lung, breast cancer patients - all stages

  13. Accreditation Developers of CoC OMH accreditation and survey criteria. Commission On Cancer Accreditation National Comprehensive Cancer Network

  14. Medical Home Projects • Come Home CMS demonstration project • 7 practice demo including NGOC • Aetna OMH pilot • Priority Health OMH in Michigan • Single Practice Demos • Linda Bosserman, M.D. and Wellpoint • John Sprandio, M.D. and Aetna • Others

  15. Key Attributes of the OMH • The clinical team “quarterbacks” the patient care which leads to an enhanced patient experience • Provides the payers better value for their Healthcare dollar • Aligns financial incentives so that community oncology practices can stay independent and expert cancer care can remain close to home

  16. Oncology Medical Home Summary Develop Quality/Value Measures Develop Patient Satisfaction Tool Oncology Medical Home

  17. Oncology Medical Home A process for all stakeholders

  18. OMH Implementation Team Implementation Committee • 8 Oncology Practice Administrators • Web site collection of resources for all stakeholders: providers, payers, and patients • Over 50 tools, technologies, templates • Champions Program • Cloud based Oncology Patient Satisfaction Survey • Over 17,500 benchmarked surveys • 1,092 providers • Over 2,400 sites of care www.medicalhomeoncology.org

  19. Patient Satisfaction Survey Benchmarking within practice

  20. Patient Satisfaction Survey Benchmarking to other practices

  21. Getting Started • Come by the OMH booth • Start with familiarizing yourself and your team with the concept. • Focus on identifying your quality and value • Begin using the free OMH Patient Satisfaction Survey • Study the results, adjust processes and behaviors • Study the results again…CQI See the “Getting Started” Document at the OMH Booth

  22. Getting Started

  23. After 500 Surveys Free customized OMH Patient Brochure

  24. After 1,000 Surveys Free customized electronic PDF to educate payers/employers

  25. Accreditation Developers of CoC OMH accreditation and survey criteria. Commission On Cancer Accreditation National Comprehensive Cancer Network

  26. Overview of Commission on Cancer • Quality Programs of the American College of Surgeons • Commission on Cancer (CoC) • National Accreditation Program for Breast Centers (NAPBC) • Bariatric Surgery Center Network Accreditation Program (BSCN) • National Surgical Quality Improvement Program (NSQIP) • Trauma Verification Program

  27. CoC OMH Accreditation Schedule • 10 pilot sites selected (7 from COME HOME) • OMH Accreditation targeted for 1 Q 2015 • To include: • Defined accreditation program with Domains, Infrastructures and Process requirements • Measures specific to Processes • Data submission with benchmarking • Site surveys • Coordinating with EMR and middleware software vendors to assist with automatic data capture.

  28. CoC OMH Accreditation Standards • 5 Domains of Care • Patient Engagement • Expanded Access • Evidenced Based Medicine • Comprehensive Team Based Care • Quality Improvement

  29. Domain 1: Patient Engagement

  30. Domain 2: Expanded Access

  31. Domain 3: Evidenced Based Medicine

  32. Domain 4: Comprehensive Team Based Care

  33. Domain 5: Quality Improvement

  34. CoC OMH IT Advisory Team Purpose – To develop and promote the intermediate and long term definitions to submit (electronically) quality, value and outcomes data to the Accreditation Registry as part of the Oncology Medical Home program. IT Advisory Team

  35. IT Advisory Team Representation

  36. Payment Reform Payer Reform Team Initial team of oncology physicians and practice administrators Transition away from a “utilization” only model to one based on meaningful and agreed upon quality, value and outcomes… • Reporting • Performance • Shared Savings • Bundling • Other • “Win, Win, Win”

  37. Payment Reform • CMMI Phase II Grant Application • Joint statement w/ASCO • Developing model from Joint statement • OMH Team working with following payers for payment reform using 19 measures: • Medicare Phase II CMMI • Aetna • WellPoint • 2 different state BCBS plans • Priority Health • Other payer discussions in progress

  38. Payment reform to date (At least those that we are aware of)

  39. Collaborative Focus Oncology Medical Home

  40. Oncology Medical Home A process for all stakeholders

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