Patient-centered cancer care (PCCC) as a roadmap to success in Alternate Payment Model (APM): A case study-based learning.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 318-318
Author(s):  
Kashyap B. Patel ◽  
Natasha Clinton
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Medicare Beneficiaries ◽  
Patient Centered ◽  
Term Care ◽  
The Us ◽  
Oncology Care ◽  
Ed Visits ◽  
Value Based Care ◽  
Improve Patient

318 Background: Cancer care is among the fastest-growing segments of the US healthcare system. In the US, total spending on cancer care has increased to $124 billion in 2010. Total costs of cancer care for the US population are predicted to increase across all phases of care. One possible way to reduce overall cost, improve patient experience, and improve outcomes is to shift care away from volume and towards value. Patient-centered cancer care (PCCC) holds the promise of addressing these issues. The Oncology Care Model (OCM), developed by CMS’s Center for Medicare & Medicaid Innovation (CMMI), is a pilot designed to assess the efficacy of PCCC for Medicare beneficiaries over the next 5 years. Our practice participates in the OCM model. We share our practice transformation into PCCC reducing cost, reduce ER visit and improve patient experience. Methods: At CBCCA, we transitioned to PCCC center for accreditation as a Patient Centered Specialty Practice (PCSP) through the National Center for Quality Assurance (NCQA). Our path for PCSP primed us for the OCM with expanded access (including same-day appointments and weekend access), reduced ER visits and hospitalizations. We predicted that transition to PCCC would lower expenses, improve the patient experience, and likely improve outcomes. Based on our projected savings with the delivery of PCCC, we expected CMMI to save about a million dollars. Upon receiving reconciliation reports from CMMI, we were pleased to see that our projections were well within the actual outcomes of savings. Results: Pursuant to our transition to PCCC we were able to reduce ED visits by 40%, hospital stay by 20%, Observation unit stay by 45%, stay in long term care unit by 40% and home health visits by 24%, resulting in overall savings to over $500,000 savings to CMS. Our patient satisfaction survey was in 75% across major parameters. Conclusions: PCCC transition is a viable option for physicians to reduce overall cost, maintain or improve outcomes and patient experience. OCM is the first major initiative that will likely validate journey towards value-based care. Close to 25% of all practices have achieved target savings.

scholarly journals Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience

2021 ◽  
Vol 10 (2) ◽  
pp. 188
Author(s):  
Linda D. Bosserman ◽  
Mary Cianfrocca ◽  
Bertram Yuh ◽  
Christina Yeon ◽  
Helen Chen ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Care Pathways ◽  
Care Plans ◽  
Quality Cancer Care ◽  
Essential Components ◽  
The Us ◽  
Oncology Care ◽  
Value Based Care ◽  
Community Team

As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.

The higher school of oncology: An educational program adopting the western oncology experience in Russia.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10512-10512
Author(s):  
Ekaterina Baron ◽  
Michelle Sittig ◽  
Vadim Gushchin
Keyword(s):  
Communication Skills ◽  
Cancer Care ◽  
Patient Communication ◽  
Patient Centered ◽  
Residency Programs ◽  
Journal Clubs ◽  
The Us ◽  
Oncology Care ◽  
Case Presentations ◽  
Based Medicine

10512 Background: Disparities in current global oncology care are a major concern for many societies. Two-year oncological training in Russia is deficient in evidence-based medicine (EBM) and effective patient communication skills, despite the fact that these dictate the ability to provide optimal cancer care. We report a 3.5-year sustained program aimed at implementing Western-oriented education among young Russian oncologists to combat these educational deficiencies. Methods: The Higher School of Oncology (HSO) is a 5-year national competitive program established to supplement the traditional 2-year Russian oncology curriculum with an emphasis on patient communication, critical appraisal of oncologic articles, multidisciplinary cancer care, and program development. A total of 35 PGY1-4 residents (8-9 residents annually) have enrolled in the program. Expatriate Russian physicians practicing in the US led 140 online educational seminars with journal clubs and clinical case presentations. Communication skills were evaluated by an independent private educational group. Results: Significant improvement of EBM knowledge was marked among HSO residents, from inability to explain basic concepts to practicing and teaching EBM. Beginning in the 3rd year of the program, residents organized educational courses and conducted journal clubs for HSO and non-HSO colleagues. Residents of the program had higher patient communication scores compared to that of residents of standard Russian programs. HSO residents promoted the spread and popularization of EBM and a patient-centered approach among attending physicians, improving the quality of cancer care. The HSO also triggered imitation of similar projects in other residency programs. Conclusions: The HSO project has pioneered EBM training and led to systemic changes in cancer patient care for Russian oncologists. This model has shown success and may be useful in overcoming global medical educational disparities in other specialties and in other countries facing similar challenges.

Utilizing an advanced practice provider (APP) led acute care clinic to improve access to high quality, patient centered, cost effective cancer care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14007-e14007
Author(s):  
Megan Spradlin ◽  
Kasey Bowden ◽  
Sarena Zabilla ◽  
Elizabeth R Kessler
Keyword(s):  
Acute Care ◽  
Symptom Management ◽  
Blood Platelets ◽  
Cost Effective ◽  
Patient Centered ◽  
High Quality ◽  
Care Clinic ◽  
Anti Cancer ◽  
Oncology Care ◽  
Ed Visits

e14007 Background: The medical oncology patient population is at high risk for adverse effects and complications related to anti-cancer treatments. The cost of oncology care is projected to reach almost $160 billion in 2020. The ongoing cost trajectory has placed a significant financial burden on patients, families, and society as a whole. The Centers for Medicare and Medicaid Service (CMS) has developed a new payment and delivery model that identifies potentially preventable conditions for ED visits/rehospitalizations among patients that are receiving anti-cancer therapies. Proposed CMS changes have created increased urgency around avoiding preventable ED visits/rehospitalizations. In response to the need for high quality, patient centered, cost effective care, we have established an APP-led acute care clinic that specializes in oncology care. Methods: The Clinical Assessment and Rapid Evaluation (CARE) Clinic offers acute care and symptom management catered to the oncology population. Patients are able to receive lab and imaging work up in addition to intervention with IV fluids, anti-emetics, opioids, electrolytes or antibiotics, as well as blood/platelets as warranted. To assess patient satisfaction, we created an anonymous four question survey delivered to CARE clinic patients over a two month period. Results: Seventy five surveys were collected. Pain and nausea were the leading reasons for encounters. 91% of patients rated their care as excellent, while 9% of patients rated their care as good. 33% of patients reported they would have been seen in the ED if the CARE Clinic was not available. Conclusions: The CARE Clinic represents a unique, one of the first of its kind, acute care and symptom management entity that utilizes an APP model to provide high quality care at a low cost. More research is needed to identify if this model can create statistically significant reduction in ED visits and rehospitalizations, however current data suggests that patients are highly satisfied with this unique method of care delivery. Sources Handley NR, Schuchter LM, Bekelman JE. Best Practices for Reducing Unplanned Acute Care for Patients With Cancer. Journal of Oncology Practice. 2018;14(5):306-313. doi:10.1200/jop.17.00081.

scholarly journals Type of Multimorbidity and Patient-Doctor Communication and Trust among Elderly Medicare Beneficiaries

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Rahul Garg ◽  
Chan Shen ◽  
Nethra Sambamoorthi ◽  
Kimberly Kelly ◽  
Usha Sambamoorthi
Keyword(s):  
Effective Communication ◽  
The Elderly ◽  
Mental Condition ◽  
Medicare Beneficiaries ◽  
Physical And Mental Health ◽  
Physical Conditions ◽  
The Us ◽  
Doctor Communication ◽  
The Relationship ◽  
Improve Patient

Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient’s sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5–97.5%) and high trust (95.4–99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed.

Designing comprehensive patient and family centered oncology care to achieve value based quality outcomes: Lessons learned from the field in creating sustainable change.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18225-e18225
Author(s):  
Tamira Harris ◽  
Lalan S. Wilfong
Keyword(s):  
Cancer Care ◽  
Gap Analysis ◽  
Care Delivery ◽  
Strong Relationship ◽  
Lessons Learned ◽  
Care Team ◽  
Need To Evaluate ◽  
Oncology Care ◽  
Value Based Care ◽  
Family Centered

e18225 Background: Of all clinical specialties cancer care is often thought of as one of the most patient and family centered due to the nature of the disease and course of treatment. Traditionally a strong relationship is held among the physicians, office practice staff and patients and family. Cancer care requires multidisciplinary collaboration and alignment for the optimized patient experience. Comparatively speaking this has been the case. The office based oncology care team has worked side by side to move the patient through the system during various treatments and settings. Most often the relationships and bonds that are formed are long lasting as cancer is a life changing experience. Opportunities for change however do exist and are needed in today’s increasingly complex healthcare environment. As demographics shift, and treatment methodologies continue to be discovered costs have escalated giving rise to the need to evaluate different care delivery models such as value based care. The Centers for Medicaid and Medicare Innovation Center (CMMI) Oncology Care Model (OCM) initiative has addressed this in their 5 year OCM pilot. Methods: Using qualitative and six sigma lean techniques practices redesigned patient throughput and experience based on data from gap analysis assessments, observation and collaboration. Results: The session will highlight lessons learned from the practice setting in initiating the changes required to meet CMS objectives and change the face of oncology care. Learn how practices designed patient navigation, created care team huddles, designed technology that facilities decision making, identified new models and partnerships for care, and standardized approaches across practice sites among other successes. Conclusions: This interactive session will explore what worked well, what physicians would change, and next steps planned.

Sustaining the gains in cancer care from the oncology care model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6632-6632
Author(s):  
Valerie P Csik ◽  
Jared Minetola ◽  
Andrew E. Chapman ◽  
Neal Flomenberg
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
The United States ◽  
Demonstration Project ◽  
Cancer Center ◽  
Care Model ◽  
Drug Expenditures ◽  
Oncology Care ◽  
Ed Visits ◽  
Feedback Data

6632 Background: The Oncology Care Model (OCM) is a 5-year demonstration project led by the Centers for Medicare and Medicaid Services (CMS) to create a framework for the future of oncology care in the United States. More than half way through the project, our large, urban NCI-designated cancer center chose to focus on and invest in resources and personnel for patient navigation and the development of clinical pathways. Although navigation has shown to reduce emergency department (ED) visits by as much as 6% per quarter compared to non-navigated patients, sustaining it is a challenge because it is a nonbillable service. Clinical pathways are a tool to reduce care variation by addressing drug expenditures, and represent an opportunity to reduce outpatient costs by as much as 35% when patients are treated on pathway.3 Many OCM practices made similar investments and all are facing the question: How will the infrastructure and efforts developed during OCM be sustainable after the demonstration project ends? Methods: An analysis of average ED cost and utilization as well as drug expenditures was conducted using OCM feedback data (Q1-Q8). Total utilization of ED visits and ED admits were used to determine a projected annualized cost which was compared to a budgeted navigation team. Similarly, projected annualized drug expenditures were compared to the annual cost of the pathways tool. Results: We found that ED visits and ED admits would need to be reduced by 11% to cover navigation costs. Similarly, a 0.7% reduction in total drug expenditures would cover the cost of clinical pathways. The OCM data represents a timeframe prior to implementation of these programs and an average increase of 1.6% per quarter for ED admits, a 0.6% decrease in ED visits and 2.7% increase in drug expenditures. This will serve as a baseline to measure progress towards our sustainability targets. Conclusions: Long term sustainability of the infrastructure developed during OCM to support cancer care transformation will be dependent on reducing high cost and highly utilized services. Aligning impact areas with resources/tools to ensure sustainability is an approach that can help define targets for OCM practices.

Improvement in incident resolution time with implementation of an electronic patient management solution at a community oncology practice.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1578-1578
Author(s):  
Lalan S. Wilfong ◽  
Amila Patel ◽  
Lance Ortega ◽  
Rhonda Boren ◽  
Ben Pearson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Management ◽  
Resolution Time ◽  
Nursing Assessment ◽  
Solution Methods ◽  
Care Models ◽  
Oncology Care ◽  
Ed Visits ◽  
Value Based Care ◽  
Oncology Practice

1578 Background: Value-based care models such as the Oncology Care Model incentivize practices to reduce hospitalizations and emergency department (ED) visits. Texas Oncology found that most ED visits occurred during regular business hours. Prolonged patient call back times were consistently rated poorly on satisfaction surveys and often led to ED visits for symptoms that could be managed in our offices. We partnered with Navigating Cancer (NC) to implement an electronic patient management technology solution. Methods: For each of our 200 locations, call volume was estimated based on clinic volume. We then reallocated or hired dedicated triage nurses and operators. Incoming calls were entered into the NC dashboard by operators as incidents which were routed based on symptom priority following system generated prompts. Incident volumes and resolution times were tracked. We instituted PDSA cycles at all locations with a goal of less than 90-minute resolution of symptom-related incidents Utilizing the electronic dashboard allowed us to continue this initiative during the COVID-19 public health emergency as our staff could work remotely. Nurses were able to document if a potential ED visit was avoided. These data points allowed our practice to establish comprehensive and strategic actions plans for quality improvement. Results: We finalized implementation of the system in February of 2020. Total incidents for 2020 were over 1 million, averaging over 5000 per location. Resolution time for all incidents started at 3.2 hours pre-implementation and improved to 2.2 hours in December of 2020. Resolution times for symptom-related incidents started at 2.3 hours pre-implementation and ended at 1.5 hours in December of 2020 with over 60% resolved under one hour. 8% of symptom-related incidents resulted in definite or probable ED avoidances by nursing assessment. Shortness of breath, vomiting, chills, and weakness were the top symptom types addressed for ED avoidances. Conclusions: An electronic patient management solution with PDSA cycles of quality improvement can markedly reduce call back times, especially for symptom related calls. We believe managing symptoms in a timely fashion will lower ED visits and hospitalizations as well as improve patient satisfaction. We will report on these outcomes once available.[Table: see text]

scholarly journals Insight into Patients’ Experiences of Cancer Care in Taiwan: An Instrument Translation and Cross-Cultural Adaptation Study

2018 ◽  
Vol 15 (8) ◽  
pp. 1772 ◽  
Author(s):  
Tsung-Hsien Yu ◽  
Kuo-Piao Chung ◽  
Yu-Chi Tung ◽  
Hsin-Yun Tsai
Keyword(s):  
Cancer Patient ◽  
Patient Experience ◽  
Cultural Adaptation ◽  
Cancer Care ◽  
Expert Panel ◽  
Cross Cultural ◽  
Patient Centered ◽  
Cross Cultural Adaptation ◽  
Centered Care ◽  
Experience Survey

Background: Since Taiwan launched the Cancer Prevention Act in 2003, several prevention strategies and early detection programs have been implemented to reduce the incidence, morbidity and mortality rates of cancer. However, most of the programs have concentrated on healthcare providers. Evaluations from the patient’s perspective have been lacking. Thus, in this study a cancer patient experience questionnaire was developed in the Taiwanese context and a preliminary nationwide investigation was conducted on the status of cancer care from the patient’s perspective. Methods: An extensive literature review was first conducted to collect information on the existing instruments used to measure the cancer patient’s experience. Thereafter, a multidisciplinary expert panel was convened to select an optimal instrument based on the IOM’s six domains for evaluating patient-centered care. The European Organisation for Research and Treatment of Cancer (EORTC) translation procedure was applied to the questionnaire for cross-cultural adaptation. A nationwide field test was then implemented at certificated cancer care hospitals. Results: Fifteen questionnaires were collected for the literature review. The expert panel selected the National Cancer Patient Experience Survey based on the IOM’s recommendations. After cross-cultural translation of the questionnaire, a total of 4000 questionnaires were administered in 19 certificated cancer care hospitals and two major cancer patient associations, with 1010 being returned (25.25% response rate). Most of the respondents were middle-aged, and 70% were female. The respondents reported they had a good experience with cancer care, except for “Home care and support” and “Finding out what was wrong with you”. Stratified analysis was conducted, with the results showing that the cancer patients’ experiences varied depending on their sociodemographic and cancer-related characteristics. Conclusions: A Taiwanese version of the cancer patient experience survey questionnaire was developed. Its results showed that the cancer patient’s experiences varied, depending on the patient’s age, cancer type, and cancer history. This study can be used as a basis to establish a patient-centered care model for cancer care in Taiwan.

scholarly journals Filling the Gap: Development of the Oncology Nurse Practitioner Workforce

2010 ◽  
Vol 6 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Brenda Nevidjon ◽  
Paula Rieger ◽  
Cynthia Miller Murphy ◽  
Margaret Quinn Rosenzweig ◽  
Michele R. McCorkle ◽  
...  
Keyword(s):  
Nurse Practitioner ◽  
Cancer Care ◽  
Care Delivery ◽  
Care Needs ◽  
Oncology Nurse ◽  
The Us ◽  
New Strategy ◽  
Oncology Care ◽  
Potential Cancer

A new strategy for oncology care delivery that includes increasing the numbers and expanding the roles of nonphysician practitioners is critically important to meet the current and potential cancer care needs of the US population.

Clinical specialist radiation therapists (CSRT): Creating capacity while improving quality of care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 124-124
Author(s):  
Elizabeth Lockhart ◽  
Michelle Ang ◽  
Laura Zychla ◽  
Kate Bak ◽  
Lynne Nagata ◽  
...  
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Models Of Care ◽  
Health Human Resource ◽  
High Quality ◽  
Term Care ◽  
Radiation Therapist ◽  
Clinical Specialist ◽  
Quality Cancer Care ◽  
Assessment And Treatment

124 Background: Ontario’s cancer system faces many challenges, including a rising incidence of cancer, aging population, increasingly complex cancer treatment, and health human resource (HHR) constraints. In response, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care collaborated on a project to assess whether a new advanced practice radiation therapist role – the ‘Clinical Specialist Radiation Therapist’ (CSRT) – could enhance access to high quality, innovative care by optimizing the use of HHR. Methods: This innovative model of care aims to enable radiation therapists with advanced training and accreditation (CSRTs) to assume responsibility for certain activities traditionally performed by radiation oncologists (ROs) while maintaining and improving the quality, accessibility and efficiency of radiotherapy (RT) for patients. To assess CSRTs’ impacts standardized metrics, including efficiency (access, wait times (WTs), team function) and quality (new/enhanced services, patient experience) measures, were used. Results: Currently there are 24 CSRTs in 9 of 14 regional cancer centres. 2014/15 data demonstrated that CSRTs can improve the efficiency of referral processes and clinic operations, decrease WTs, and increase capacity (2-28 additional patients seen in clinic/month). Optimized team function and time savings (5-66 RO hours/month) have been achieved through CSRTs’ assumption of certain patient assessment and treatment planning activities. Efficiencies have improved patient experience by facilitating quicker, more coordinated flow through the RT process, and greater continuity of care. Further, CSRTs have enhanced access to high quality RT, through > 75 innovative initiatives (rapid access clinics, telemedicine consults). Conclusions: The CSRT role demonstrates how innovative models of care can improve patient access to high quality cancer care. With 24 CSRTs implemented, opportunities for analysis of factors which facilitate achievement of maximal impact and position sustainability exist. Such investigations could inform the refinement and further implementation of CSRTs in Ontario and other jurisdictions, improving patients’ access to RT more broadly.

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