Cost-Effective Cancer Care: Thoughts from Leading Physicians

Dallas, TX—Can we create a system of care that will demonstrate cost-effectiveness and change the way oncology is being practiced? This was the focus of several provider-driven innovative solutions discussed at the 2012 Cancer Center Business Summit.

We have learned that we must collect and share information, develop benchmarks, and make them actionable. The panelists described 4 distinct oncology models that are being developed toward effective cancer management.

Innovative Oncology Business Solutions: Oncology Medical Homes
Barbara L. McAneny, MD, Chief Executive Officer, New Mexico Oncology Hematology Consultants, Albuquerque, described a 3-year, $19.7-million grant that was recently awarded by the Centers for Medicare & Medicaid Services (CMS) to a new company that she created named Innovative Oncology Business Solutions. This grant will support the infrastructure and software to develop community oncology medical homes in New Mexico, Florida, Georgia, Maine, Ohio, Pennsylvania, and Tennessee.

“We seem to have learned in oncology that good practices have to be designed around patient flow and building processes that manage patients and their care. Programs that focus solely on drugs and cutting costs become self-limiting,” Dr McAneny stated.

A bundled payment model will be established to pay the physicians a set amount to manage their patients. In addition, the program will develop a personalized medicine program for Medicare patients with cancer that will include genetic testing.

Another key feature of the program is the use of triage processes that integrate nurse care managers with the practice.
The results from these practices will be compared with data from CMS on how patients are being treated at major cancer hospitals across the country, with the expectation that the community practices would show the same quality of care as CMS, or better, but at a lower cost.

Dr McAneny observed that “part of this transitional process is going to be engaging and teaching patients how and when to contact their physician to better manage clinical outcomes.” In addition, she noted that the oncology community will “also have to come up with specific mea­sures of the patient experience—the whole experience, not just the clinical outcomes and experience. The top 2 complaints we hear from pa­tients are ‘we have been waiting too long for care,’ and ‘no one listened to me, and what I was trying to say.’ ”

Engaging the Patient: Cancer Treatment Centers of America
Cancer care at the Cancer Treatment Centers of America (CTCA) in Schaumburg, IL, is focused on engaging the oncology consumer, according to Stephen B. Bonner, President and Chief Executive Officer of CTCA. Patients self-refer to CTCA for treatment, and Mr Bonner described the manner in which CTCA engages the oncology consumer in making informed choices about their care.

He believes that oncology patients are hungry for information about their choices, their treatments, and about side effects and how to manage them. CTCA has a widespread direct-to-consumer focus, and it publishes self-reported quality results on its website, by cancer type and site.

Another CTCA initiative is transparent pricing. Many of their patients travel up to 300 miles one way for care, and they appreciate the work that CTCA has done to build a bundled pricing for the evaluation services, including guarantees for the timing of the evaluation and provision of a written care plan.

Bundled pricing for treatment is also in development. CTCA is underwriting research to allow consumers to define quality in oncology, and it is identifying meaningful future metrics for quality measurement in oncology. Mr Bonner expects that “Real-world care models and outcomes and payment models will eventually be more powerful in determining effective and appropriate care than clinical trials.”

Value-Based Cancer Network: John Theurer Cancer Center
Andrew L. Pecora, MD, FACP, CPE, Chief Innovations Officer and Professor and Vice President of Cancer Services, John Theurer Cancer Center at Hackensack University Medical Center, NJ, de­scribed an oncology model for clinical integration by the establishment of Value-Based Cancer Network.

In New Jersey, 80 like-minded oncologists (with dozens more soon to join) have designed Regional Cancer Care Associates, with the goal of oncologists taking action to coordinate efforts with health plans and drug companies to provide quality cancer care to patients, while reducing the cost of care. Each practice will retain autonomy (the physicians will be able to make specific medical decisions for their individual patients), but a doctor-dominated board of trustees will standardize the care and will identify the relative effectiveness of chemotherapies or the number of diagnostic tests that will be appropriate.

In the face of escalating costs of cancer care as a result of the growing population and because people are living longer and are getting cancer, models such as the Value-Based Cancer Network are focused on rational care by providing the treatments that offer best survival rates, at a reasonable cost.

Hospital–Physician Partnership Model: The West Clinic
Erich A. Mounce, MHA, Chief Executive Officer, The West Clinic, Memphis, TN, and Lee Schwart­z­berg, MD, FACP, Medical Director, The West Clinic, and Chief, Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, described how The West Clinic has continued to evolve from a 1-stop, quick, efficient, and economical community oncology practice.

The West Clinic has always been at the center of cancer care innovation and quality, including being a founder of the Cancer Clinics of Excellence and now participating in an episode-of-care payment model with UnitedHealthcare.
Recognizing that there are limitations to the cost-savings that a single practice can achieve without touching on huge cost drivers embedded elsewhere along the entire spectrum of care delivered outside of its offices, The West Clinic developed a request for proposal for possible partners among the hospitals that were in its local market. One partner was selected because of the presence of a shared vision and willingness to move forward with initiatives and a desire to take better care of the community. This partnership is becoming the vehicle to get better access to data covering the full continuum of care.

Dollars are now being saved through improved drug pricing programs. (The hospital partner participates as a designated-services hospital and receives access to drug pricing programs that allow the practice and the hospital partner to serve the uninsured members of the community.) These programs are being used for unfunded services that did not previously exist—patient navigation, physical therapy, and building a multidisciplinary approach to cancer care.

The partnership includes integration of research.
Part of the reason The West Clinic decided to expand its services and to include a partner was that its referral base was being captured by a competing hospital in the marketplace. A key element of the partnership is a management agreement: The West Clinic’s physicians manage the entire service line now.

Mr Mounce said that “engaging senior leadership is imperative. The Chief Executive of Operations and the Chief Financial Officer of this 7-hospital system sit with us monthly as we develop programs.”

Out of concern for the challenges that the patients and the payers may face that arise when private practices shift to hospital-based programs, the hospital and The West Clinic approached all payers collaboratively to figure out how they could bill as a hospital provider, but under the physician setting contracts.

This innovation allowed the patients’ copays and the patient and health plan billings to remain the same and to not rise as a result of the partnership. The hospital partner walked away from millions of dollars in potential higher billings by agreeing to this component of the partnership, and this then allowed deeper engagement of patients and patient management.

The next steps will include moving toward development of quality outcomes and patient outcomes that will further drive quality discussions.

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