The Centers for Medicare & Medicaid Services (CMS) is forcing a game-changing revolution on healthcare. With its target of tying 30% of Medicare payments to quality- and value-based care through alternative payment models by 2016, and 50% by 2018, CMS is pushing through payment changes with what seems like a new program every month or so.1
On March 8, CMS announced its latest proposed initiative, the Comprehensive Primary Care Plus model.1 Although this new proposal targets primary care physicians, it will also affect oncology practices for 2 major reasons—patients and provider groups.
This new 5-year program from CMS is intended, among other things, to support patients with serious or chronic diseases to achieve their health goals; to deliver preventive care; and to work together with hospitals and other clinicians, including specialists, to provide better coordinated care. The program is focused on comprehensive care that is patient-centered: the patients at highest risk are expected to receive proactive, relationship-based care management services.
Patient Management: Oncology and Primary Care
The intersection with oncology in this new proposal will come from the overlap in patient management, particularly for oncology practices that are implementing CMS’s Oncology Care Model (OCM) or the oncology medical home model; it may possibly result in competition for the chronic care management codes that many practices are gearing up to start billing. Many oncology centers are part of larger groups encompassing primary care physicians. The coordination, management, and support of patients with cancer may result in an overlap of initiatives between oncologists and primary care physicians.
You may ask, “Why is this different for us? We manage our patients, and very well, thank you very much.” Well, we may not be doing such a good job. As I watch practices start to gear up for their imminent participation in the CMS OCM, certain gaps are becoming clear. We treat our patients, but we do not always manage them well.
A plethora of vendors are currently pushing tools at oncology practices to meet the OCM data targets and documentation targets, but they are often only offering additional software tools and clickable documents. These solutions seem very shallow.
To meet the expectations of CMS and other emerging private payers and employers, we will need to do more than have a checklist of patient navigation steps or fill out a care plan or a survivorship plan.
True patient management will have to embrace a rethinking of our basic model: moving from treatment to management. It will no longer be enough to answer the phone with new triage pathways; we will need to work hand in hand with other physicians to touch, track, and engage the patient outside of office visits.
Questions for Your Practice
As you look at vendor solutions for better patient management, it may help to ask questions such as:
- Is this merely a set of forms presented in a software package?
- Does this vendor have any experience with direct patient management in the “field”?
- Does this vendor offer staff resources experienced in touching patients directly, in the home, in the office, and in between?
- Does this “solution” allow me to interact with other care providers in my system or outside in a way that meets my needs and theirs?
- Are we still in treatment mode?
- Are we considering what we need to know from patients, as well as what they need to know from us?
- Do we see our patient as a comprehensive system, with multiple facets, or only from the perspective of the oncology diagnosis?
- Are we creating solutions that proactively reach out and touch our patients before they decide to call us?
- Do we need to consider other teams and staff to augment our outreach in a more cost-effective manner than solely using existing teams and models?
- Are we ready to embrace this patient management revolution?
- Centers for Medicare & Medicaid Services. CMS proposes to test new Medicare Part B prescription drug models to improve quality of care and deliver better value for Medicare beneficiaries. Press release. March 8, 2016. www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-08. html. Accessed April 11, 2016.