The new proposed Centers for Medicare & Medicaid Services (CMS) Enhancing Oncology Model (EOM; see “From the Editor” article on https://www.oncpracticemanagement.com/issues/2022/august-2022-vol-12-no-8/2926-getting-real-with-the-new-enhancing-oncology-model) sets forth the expectation that medical practices will actively engage with patients as they go about their daily lives between office visits, tracking symptoms, and monitoring adverse events that can lead to costly medical interventions. Many physicians may believe that they are already well-connected to their patients through reminders to “call in” and outbound nurse calls at certain points of treatment. The reality is that digital therapeutics have exploded in recent years. Employers, health plans, and emerging healthcare entities are changing patient expectations and engagement with innovative blends of technology and personal interaction, in ways that most physicians cannot yet imagine. How then, can a medical practice adapt to this emerging field? How does a specialty oncology practice embrace the Participant Redesign Activities named by CMS as success factors under the new EOM?
Stepping Out of the Medical Office and into the Patient’s World
Patients being treated for diseases such as cancer face physical symptoms, as well as mental health and life challenges, which can significantly impact patient outcomes and costs of care and increase the demands on the clinical and administrative resources of a practice.
Practices do not have the staff or the technology to adequately meet the EOM’s patient engagement demands alone. Many will be looking for a care partner for the patient engagement functions. Using a telehealth vendor or automated call reminders will not be sufficient to lead to success. Practices will need to search for care partners that specialize in the science of behavioral health, supporting patient engagement that moves well beyond the traditional limitations and restrictions facing providers (even with the advent of telehealth).
What Is a Digital Therapeutic?
Patient portals, follow-up calls, and telehealth are common ways that healthcare providers communicate with their patients. Although these technologies and outreach methods certainly have a role in patient care, they lack the dynamic ability to interact with patients on a continuous basis in real time. This fact, combined with the reality that nurses and case managers are overworked and have a limited amount of time to complete their duties each day, let alone contact the hundreds of patients for which they are responsible, will result in unrealistic expectations unless practices can find resources that will enable them to scale the support they are charged to offer. Enter digital therapeutics.
Quite simply, a digital therapeutic is a patient engagement tool and process that actively extends a patient’s care plan into their daily life on their own terms, and perhaps most importantly, it should improve the patient’s ability to harmoniously incorporate that care plan into their lifestyle. It is an interactive, mobile messaging and web-based program that patients access via any web-enabled device (eg, smartphone, desktop, laptop, handheld, wearables) that assists in implementing their care plan and connects them to their healthcare team.
Digital therapeutics can serve as a trusted, nonjudgmental but helpful personal concierge, available on a 24/7 basis when the patient needs a response or support, providing remote care and service coordination, education, activities, and scalable interactions, that will lead to improvements in psychosocial, adherence, and readmission reduction. All this is done in close connection with the patient’s medical team, supporting the care plan for the patient and making it manageable in the chaos of daily life. In addition, digital therapeutics can be branded under the medical office, avoiding confusion for patients, and providing assurance that their physician is overseeing their care outside of the office walls.
Looking for Experienced Care Partners
Practices may not be aware of how advanced patient engagement has become. One behavioral health focused provider, GoMo Health, designs carefully planned patient encounters with high engagement rates and a wide variety of resources. This provider integrates the science of how to interact with patients and covers the gamut of health and wellness issues that can affect any of us, including those dealing with a disease such as cancer, while considering the complete person and how daily living impacts their ability to effectively follow their care plan via their proprietary BehavioralRx program.
As an example of the increasing growth of digital therapeutics, in 2021 alone, GoMo Health connected with members and patients through more than 21.8 million encounters, avoided more than 240,000 costly medical escalations and adverse events, saved more than $250 million, and maintained a 96% member retention rate. The digital health programs are enhancing patient engagement for physician practices, Medicare, commercial, Medicare Advantage health plans, and Medicaid programs.
In this article, we will use GoMo Health's services to illustrate the depth of digital health programs available to providers, and discuss what you should look for in potential care partners.
GoMo Health provides continuous individualized and real-time patient and caregiver outlook monitoring, digital nurturing education, guidance, and interactive activities based on the patient’s phase of the cancer journey and integrates its evidence-based psychosocial support and content (including improving sleep and reducing anxiety and stress). The digital patient encounters are further personalized for each individual by proactively anticipating treatment-related side effects, planning for next appointments, and providing guidance and support for patients to cope with home and work challenges, as well as how to stay physically and emotionally connected with family and friends. Since cancer presents challenges to the entire family, it is important to also engage caregivers so they can receive information that will help them better support their loved ones and lower their own levels of anxiety and stress. Unique digital engagement therapeutics for palliative care can help to detect when patients may be eligible for these services and refer patients to the palliative care clinical team for onboarding.
Integrating Behavioral Health Science with Patient Care at Home
Integrating the science of behavioral health and adding care in the patient’s home between office visits is a turning point in population management for medical practices. When patients become more actively engaged in their oncology care and can overcome daily challenges with proactive digital therapeutics, adherence is improved, which helps to reduce everyday burdens on the practice team. These results are achieved by applying evidence-based behavioral science and a telehealth system of remote care that makes it easier for patients and clinicians to achieve their desired goals.
By applying the principles of behavioral psychology and cognitive neuroscience, physicians can help patients achieve desirable actions, activities, and behaviors without burdening their precious staff resources. GoMo Health has developed the evidence-based science of engagement, BehavioralRx, based on these principles. BehavioralRx promotes shared decision-making and can establish cognitive connections between regular daily activities and new actions related to a patient’s care. The technology provides nurturing, guidance, and personalized components to care that help patients stay on track with their therapies while still living their daily lives.
Automating Education, Self-Help, and Community Resource Connections
Using its evidence-based behavioral and cognitive science of patient and family engagement, GoMo Health collects more than 100 life factor data points longitudinally on the patient and family psychosocial, physical, and environmental state and, via machine learning, discovers patterns, trends, and early warning signs of potential adverse events and/or lack of adherence and escalates to the appropriate clinical resource. With multiple contracts for commercial, provider, Medicare, and Medicaid patient engagement, GoMo Health demonstrates the value of integration of a variety of community resources daily and has a vast and still growing network of these resources across the United States. Interactive referrals and outcomes tracking provide far more value to patients and physicians than a hanging file folder of contacts in a medical office desk.
GoMo Health also provides a superset of the required EOM beneficiary health-related social needs (HRSN) functionality screening and reporting, including a library of upcoming required social service Z codes; real-time closed-loop referrals to social services and community-based organizations providing valuable services as well as psychosocial support services; and automated patient follow-up and escalation to practice on patients’ activation of these social services and their satisfaction levels.
Meeting Assessment and Screening Requirements without Increased Demands on Medical Practices
GoMo Health has many of the evidence-based electronic patient-reported outcome (ePRO) surveys, assessments, and screening tools built in. It also enables a practice to create an intelligent electronic assessment (as requirements shift) in under 5 days. All data are easily exportable to an electronic medical record, case management, or data analytics system and an automated programming interface enables real-time data exchange with practice systems.
Digital Therapeutic Technology Can Support Oncology Practices Facing Risk Models
Cancer center administrators find savings and value in a digital Concierge Care program, used as an out-of-the-office extension for patient outreach, very similar to the requirements by CMS for the EOM model.
Care Coordination and Data Collection for Quality and Outcomes
“The most obvious cost-savings are related to fewer emergency department readmissions and fewer hospitalizations. Also, because Concierge Care is continuously reinforcing what the clinical team tells their patients, it can reduce the strain on care coordination by collecting critical patient information and escalating high-impact situations,” said Deborah Toppmeyer, MD, Chief Medical Officer, Rutgers Cancer Institute of New Jersey, New Brunswick, regarding her institution’s use of the GoMo Health Concierge Care digital therapeutic program.
Concierge Care provides telehealth services and increased ePRO data collection needed for reimbursement and compliance with the Oncology Care Model (and the upcoming EOM) value-based payments. It also deepens data and helps centers meet and exceed mandatory quality measures from CMS and commercial plans.
Treatment-Based Patient Support
A OneOncology physician-owned, multispecialty community oncology practice serving 12,000 new patients annually engaged GoMo Health to improve their remote patient engagement complementary to the care provided in the office. With the goal of supporting best practices in the treatment of breast, lung, and prostate cancer, the digital therapeutic program provides personal concierge messaging and support to patients as they undergo treatment with either oral oncolytics and/or infusions. Patients will also benefit from inclusion in a psychosocial support platform, designed to better integrate patients with their treatment and cancer support community, and to equip them with tools and resources to support their emotional well-being during a cancer treatment journey during, and despite their busy personal daily lives. This group has already begun several of the patient engagement steps that will be required for possible participation in the EOM program, before the program was even announced.
High Patient Engagement, Strong Desirable Outcomes
A National Cancer Institute–Designated Comprehensive Cancer Center digital therapeutic oncology Concierge Care program (working with GoMo Health) reaches out to patients for follow-up, symptom and side-effect occurrence, and patient satisfaction and is now experiencing an 89% patient engagement completion rate, reduced emergency department visits, and improved medication adherence rate.
What to Look for in Potential Digital Care Partners to Support the EOM
What should oncology practices look for in potential digital care partners, to support the EOM and other care value initiatives? Ask if the program can do the following:
- Augment, track, and monitor satisfaction with patient navigation outside the medical office, as appropriate.
- Support and track outside the office applicable elements of the practice care plan for each patient that contains at a minimum the 13 components of the Institute of Medicine Care Management Plan.
- Support and track patient care/experiences for patients in a manner consistent with nationally recognized clinical guidelines.
- Provide caregiver-focused programs to supplement patient programs.
- Demonstrate success in patient engagement with underserved populations, including dual eligible and Medicaid.
- Provide patient support, tools, and specialized programs in a variety of languages, including Spanish, Russian, Hebrew, Arabic, Chinese, native American Indian, etc.
- Identify, track, and support the implementation of patient HRSN using an HRSN screening tool, in collaboration with the medical practice.
- Demonstrate proven compliance with and successful execution of ePROs.
- Demonstrate proven collection, utilization, and reporting of data for continuous quality improvement.
- Demonstrate proven successful execution and integration with Certified Electronic Health Record Technology as specified in 42 Code of Federal Regulations § 414.1415(a).
- Demonstrate proven track record and success in patient engagement programs that:
- Reduce acute care utilization
- Provide scalability
- Implement successful ePROs tools
- Offer activities that promote health equity
- Reduce financial toxicity
- Improve psychosocial outcomes
- Provide psychosocial care during chemotherapy treatment and survivorship
- Increase shared decision-making around the goals of treatment
- Enhance the quality of care and fragmented care between different providers, and other community programs and resources
- Improve transitions between care settings (including better communication with the primary care physician)
- Increase medication adherence
- Support enhanced adoption of evidence-based treatment guidelines and high-value therapies
- Improve symptom management
- Provide more informative education at treatment initiations to better symptom management
- Incorporate palliative care resources and education as appropriate throughout the course of treatment
- Increase understanding and use of hospice at the end of life.
The Revolution Is Here, But Who Will Drive It?
The EOM proposal is likely to start a new revolution in healthcare. CMS is not alone; billions of dollars are being invested by nonphysicians and nonhospital systems in healthcare disruption and innovation that could completely transform our vision of what encompasses quality, effective, and cost-efficient healthcare. Will the traditional healthcare delivery system transform care as leaders, or will it allow others to step up?
For physician practices, the extension of their medical management of patients to the times when the patient is in the middle of their chaotic daily life may be a new concept, but is likely to soon emerge as a “how did we ever function any other way” moment. This cannot be done with existing staff, technology, and models in the medical office. There are some great potential partners out there and using this information should help you to find the right one for your office, regardless of whether you choose to apply for the EOM program.
Ms Holcombe is President, DGH Consulting, South Windsor, CT (dawnho@aol. com); Mr Gold is Chief Behavioral Technologist and Chief Executive Officer, GoMo Health, Asbury Park, NJ (