Exploring Ways to Translate the Medical Home Model into Oncology

With today’s focus on the National Committee for Quality Assurance’s Patient-Centered Medical Home (PCMH) as a viable option for healthcare delivery and cost reform, a group of researchers explored how best to translate the concept from the primary care model to oncology care. What they found is that an Oncology Medical Home (OMH) model may revolutionize cancer care and reimbursement (J Clin Oncol. 2011;29[suppl]:Abstract e16641). With their background in identifying breast cancer care coordination challenges, Trosman and colleagues interviewed patients, providers, and payers regarding which characteristics would be most desirable in an OMH for breast cancer care. Four characteristics emerged as important features to include when developing a model for oncology:

1. Each OMH should have a lead physician, in this case, an oncologist or breast surgeon, for the entire episode of cancer care. Survivorship care should be transferred back to the primary care physician, with a corresponding PCMH.  2. A lead physician should facilitate care across the multidisciplinary cancer care team, including surgical, medical, and radiation oncology; radiology; supportive care; and primary care.  3. Each patient’s care and care team should be managed as a project, with key events sequenced and timed in a plan, by a “care project manager.”  4. A unique reimbursement model should be implemented that incentivizes team participation and coordination.

Most (89%) patients reported a strong desire for a lead physician, but only one third (33%) noted an interest in the reimbursement reform potential. Providers expressed high interest in all 4 characteristics (73%-85%). Most (88%) payers recognized the potential for a new reimbursement model; however, they disclosed their uncertainty with the specifics of the remaining 3 characteristics.

OMH pilots, such as the first recognized OMH Consultants in Medical Oncology and Hematology, are needed to inform specific implementation strategies. As the first OMH, the process took approximately 7 years to implement. However, practice lead physician John D. Sprandio, MD, told Oncology Practice Management that, with that experience behind them, his group has helped streamline the process for others, which he foresees as taking only 1 year for other groups.

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