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.

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community

2017 ◽  
pp. 460-466 ◽  
Author(s):  
Ron Kline ◽  
Kerin Adelson ◽  
Jeffrey J. Kirshner ◽  
Larissa M. Strawbridge ◽  
Marsha Devita ◽  
...  
Keyword(s):  
New York ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Center ◽  
Fee For Service ◽  
Community Practice ◽  
Care Model ◽  
Practice Redesign ◽  
Oncology Care

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.

Potential Winners and Losers: Understanding How the Oncology Care Model May Differentially Affect Hospitals

2021 ◽  
pp. OP.21.00050
Author(s):  
Joel E. Segel ◽  
Eric W. Schaefer ◽  
Nicholas G. Zaorsky ◽  
Christopher S. Hollenbeak ◽  
Haleh Ramian ◽  
...  
Keyword(s):  
Medical School ◽  
Care Model ◽  
For Profit ◽  
Medicare Data ◽  
Higher Ed ◽  
Oncology Care ◽  
Ed Visits ◽  
Breast And Prostate Cancer ◽  
Expected Mortality ◽  
Rural Patients

PURPOSE: With the introduction of the Oncology Care Model and plans for the transition to Oncology Care First, alternative payment models (APMs) are an increasingly important piece of the oncology care landscape. Evidence is mixed on the Oncology Care Model's impact on utilization and costs, but as policymakers consider expansion of similar models, it is critical to understand the characteristics of hospitals that may be differentially affected. METHODS: We used 2007-2016 SEER-Medicare data to identify patients with breast and prostate cancer receiving chemotherapy, endocrine therapy (breast), or androgen deprivation therapy (prostate). For each hospital, we calculated 6-month expected mortality, emergency department (ED) visits, inpatient admissions, and costs, all commonly collected APM outcomes. After calculating observed-to-expected rates for each outcome by hospital, we estimated the association between observed-to-expected rates and characteristics of each hospital to understand hospital characteristics that might be associated with higher- or lower-than-expected rates of each outcome. RESULTS: Hospitals with > 15% rural patients had significantly higher-than-expected mortality (0.31 points higher, P < .001) and ED visit rates (0.10 points higher, P = .029) as well as significantly lower costs (0.06 points lower, P = .004). Hospitals unaffiliated with a medical school also experienced significantly higher-than-expected mortality and ED visits. Hospitals eligible for disproportionate share hospital payment experienced significantly higher ED visits but lower costs. For-profit hospitals experienced higher-than-expected mortality. CONCLUSION: Rural hospitals and those unaffiliated with a medical school may require special consideration as APMs expand in oncology care. Designated cancer centers and larger hospitals may be advantaged.

Centers for Medicare & Medicaid Services' Oncology Care Model: Delivering Higher Value Cancer Care

2017 ◽  
Vol 101 (5) ◽  
pp. 569-571 ◽  
Author(s):  
LK Mortimer ◽  
LM Strawbridge ◽  
EW Lukens ◽  
A Bassano ◽  
PH Conway ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Model ◽  
Oncology Care

Reducing the Cost of Cancer Care: How to Bend the Curve Downward

2012 ◽  
pp. e46-e51 ◽  
Author(s):  
Thomas J. Smith ◽  
Bruce E. Hillner ◽  
Ronan J. Kelly
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
Cost Curve ◽  
Evidence Based ◽  
Curative Therapy ◽  
Appropriate Care ◽  
Insurance Costs ◽  
Oncology Care ◽  
The Cost ◽  
Care Costs

Overview: Health care and cancer care costs are rising unsustainably such that insurance costs have doubled in 10 years. Oncologists find themselves both victims of high costs and the cause of high-cost care by what we do and what we do not do. We previously outlined five ways that oncologists could personally bend the cost curve downward and five societal attitudes that would require change to lower costs. Here, we present some practical ways to reduce costs while maintaining or improving quality, including: 1) evidence-based surveillance after curative therapy; 2) reduced use of white cell stimulating factors (filgrastim and pegfilgrastim); 3) better integration of palliative care into usual oncology care; and 4) use of evidence-based, cost-conscious clinical pathways that allow appropriate care and lead to equal or better outcomes at one-third lower cost.

Quantifying episode-based costs of care under the oncology care model: Analysis of Medicare beneficiaries in the UAB cancer community network.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 19-19
Author(s):  
Courtney Williams ◽  
Andres Azuero ◽  
Maria Pisu ◽  
Karina I. Halilova ◽  
Warner King Huh ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cancer Drug ◽  
First Episode ◽  
Administrative Claims ◽  
Care Model ◽  
Community Network ◽  
Costs Of Care ◽  
Anti Cancer ◽  
Episodes Of Care ◽  
Oncology Care

19 Background: The Oncology Care Model (OCM) is a specialty care model developed by the Centers for Medicare & Medicaid (CMS) Innovation Center aimed at providing higher quality, more highly coordinated cancer care and reducing costs for patients undergoing chemotherapy. The OCM calculates costs of care in a novel way by anchoring costs within episodes of care, defined as six-month intervals triggered by initial anti-cancer treatment, as opposed to diagnosis date. The purpose of this study is to assess costs within the OCM episodes of care. Methods: This was a secondary analysis of Medicare administrative claims data for beneficiaries 65 and older with cancer who received anti-cancer drug treatment (chemotherapy, hormone therapy) between 2012-2015 at an institution in the UAB Cancer Community Network (CCN). Total and service-specific costs (Medicare reimbursement to providers) per patient-episode were summed from inpatient, outpatient, chemotherapy, radiation therapy, testing/pathology, evaluation and management (E/M), home health, skilled nursing facility (SNF), and hospice claims. Prescription drug costs were not included. Mean costs for the first three OCM episodes were calculated and compared to (1) diagnosis-based costs (six-month intervals starting at cancer diagnosis) and (2) service type. Results: Average total cost in the first three OCM episodes of care was $24,922 (n=13,902), $18,534 (n=6,618), and $16,548 (n=4,672). Compared to episode-based cost, average total diagnosis-based cost was higher in the first episode of care ($33,244, n=9,615), and lower in the second and third episodes ($17,143, n=9,110; $12,897, n=8,002). Episode-based outpatient, inpatient, and chemotherapy costs were the highest service-specific costs in all three episodes of care (1st: $8,374, $5,493, $2,445; 2nd: $6,188, $3,913, $3,158; 3rd: $5,909, $3,251, $3,399). Conclusions: Costly chemotherapy and inpatient and outpatient visits indicate an opportunity for targeted improvement resulting in higher value care. Knowledge of current costs of care will aid oncology practices in transition to the OCM and in usage of value-based services for better quality cancer care.

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.

Frontline oncology care team primary palliative symptom guideline education, the oncology care model, and emergency department visits.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 143-143 ◽  
Author(s):  
Susan McInnes ◽  
Cheryl M Carrino ◽  
Laura Shoemaker
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Cleveland Clinic ◽  
Care Quality ◽  
Emergency Department Visits ◽  
Care Model ◽  
Main Campus ◽  
Palliative Care Teams ◽  
Oncology Care ◽  
Ed Visits

143 Background: The Oncology Care Model (OCM) is a novel 5-year quality-based Oncology payment and care delivery program established by the Centers for Medicare & Medicaid Service in 2016. OCM prioritizes high-quality, coordinated care for patients undergoing chemotherapy (chemo pts.) Participating centers provide augmented services to enhance care and meet quality goals. Challenging symptoms (sxs) are common among chemo pts and may lead to hospitalization and decreased quality of life. Specialist palliative care teams are not able to see all chemo pts with active sxs. Front line oncology care teams (FLC) need education on primary palliative sx management. Methods: Cleveland Clinic Taussig Cancer Institute is one of 181 practices voluntarily participating in OCM. Locations include main campus and 5 regional cancer offices with 100 oncologists caring for about 4,000 chemotherapy patients annually. Our OCM team engaged Oncology (Onc) and Palliative Medicine (PM) providers to standardize sx management. Education was provided to FLC of all disciplines. Electronic record analytics were used to determine emergency department (ED) utilization. Results: A multidisciplinary team of Onc and PM experts developed guidelines for 4 common sxs (chemotherapy-induced neuropathy, persistent cancer pain, nausea/vomiting and constipation. Guidelines were approved by key Onc and PM staff and made available to all providers online. There were 4 educational sessions for FLCs to all sites in 2017. Urgent sx outpatient appointment slots were created in oncology offices to address uncontrolled sx. From Dec 2017 to May 2018, ED visits for all cancer patients at main campus decreased from 500/month to 453/month (9.4%.) Reductions in ED visits were also seen at 2 hospitals adjacent to regional cancer centers (16% and 6%.) Conclusions: OCM participation provided an opportunity to improve care quality at our institution. Primary palliative sx guidelines were successfully developed by an interdisciplinary team and disseminated to FLC. Urgent sx management appointments were made available in oncology offices. These interventions coincided with a reduction in ED visits for all cancer patients.

The formulary process for biosimilar additions at a comprehensive cancer center

2021 ◽  
pp. 107815522110367
Author(s):  
Lauren M Aschermann ◽  
Charlotte M Forshay ◽  
Julie Kennerly-Shah ◽  
Jeffrey Pilz
Keyword(s):  
Access To Care ◽  
Cancer Care ◽  
Biologic Agents ◽  
Ohio State University ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
State University ◽  
Patients With Cancer ◽  
Oncology Care ◽  
The Ohio State University

Biological products may be used to diagnose, prevent, treat, and cure diseases and medical conditions, including cancer. Biosimilar agents, approved under an abbreviated 351(k) pathway, continue to increase in number and market share for biologic agents, especially for cancer care. Although biosimilars offer the potential for improved access to care, their introduction to the marketplace has created significant disruption. It is imperative that health systems providing care to patients with cancer develop a well-defined process to address the challenges associated with biosimilars. This descriptive article outlines pharmacy considerations for biosimilars and describes the current practices at The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University. Biosimilars have and will continue to significantly impact oncology care. Organizations must understand the clinical, operational, and financial challenges associated with the use of these products.

Assessing the use of low value oncology care following the release of Choosing Wisely guidelines.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18861-e18861
Author(s):  
Alexander Gunn ◽  
Melissa Sarver ◽  
Samantha J Kaplan ◽  
Yousuf Zafar ◽  
Rachel Adams Greenup
Keyword(s):  
Cancer Screening ◽  
Guideline Adherence ◽  
Cancer Care ◽  
Systemic Treatment ◽  
The United States ◽  
Choosing Wisely ◽  
Surveillance Imaging ◽  
Patient Reported ◽  
Oncology Care ◽  
The Impact

e18861 Background: Low -value care contributes to the high costs of cancer treatment. Almost a decade has passed since the American Society of Clinical Oncology (ASCO) Choosing Wisely campaign identified costly diagnostic testing, radiographic imaging, and therapies that are routinely utilized in cancer care despite lacking evidence of benefit. We sought to evaluate the impact of ASCO Choosing Wisely guidelines and to identify barriers to and facilitators of guideline adherence. Methods: A systematic review of published literature from 2012-2021 was performed in accordance with PRISMA guidelines on the trend in use of low value oncology care. All ten of ASCO Choosing Wisely Guidelines were selected for inclusion; these included recommendations focused on cancer screening, staging and surveillance imaging, and systemic treatment and support. The following databases were searched for original research based in the United States: PubMed, CINAHL, Embase, Web of Science, Scopus, and ASCO Meeting abstracts. Eligible studies were examined for information on design, population, and study outcomes, which included guideline adherence and facilitators and barriers to implementation. All citations were independently dual-screened in a blinded fashion by authors (AG, MS). Results: 35 independent studies were identified from 3,590 unique citations and included n = 1,130,216 patients. Data sources captured large claims database analyses (13 studies, n = 1,069,289), institutional studies (14 studies, n = 53,358), patient-reported surveys (2 studies, n = 915), and interventional studies (6 studies, n = 6654). Adherence to ASCO Choosing Wisely guidelines ranged from 13% to 100% overall. Use of low value oncology care varied depending on the area of recommendation, such as cancer screening (44% to 77%), staging and surveillance imaging (30% to 100%), and systemic treatment and support (13% to 100%). Adherence was facilitated by: (a) physician awareness of and education around the recommendations; (b) patient engagement; (c) embedded EHR best practice alerts; (d) guideline alignment with insurance payer requirements; and (e) integrated healthcare systems. Barriers to guideline incorporation included perceived patient anxiety and concerns about patient satisfaction; illness-specific practices; and time needed for patient-provider conversations regarding low value care. Conclusions: Adherence to the ASCO Choosing Wisely guidelines is variable across the cancer care continuum. Health system and policy-level interventions are needed to further reduce the overuse of low value care in oncology.

scholarly journals Share of Oncology Versus Nononcology Spending in Episodes Defined by the Centers for Medicare & Medicaid Services Oncology Care Model

2018 ◽  
Vol 14 (11) ◽  
pp. e699-e710 ◽  
Author(s):  
James R. Baumgardner ◽  
Ahva Shahabi ◽  
Mark T. Linthicum ◽  
Christopher Zacker ◽  
Darius N. Lakdawalla
Keyword(s):  
Lung Cancer ◽  
Drug Therapy ◽  
Chronic Myeloid Leukemia ◽  
Cancer Care ◽  
Myeloid Leukemia ◽  
Small Cell ◽  
Care Model ◽  
Small Cell Lung ◽  
Oncology Care ◽  
Oncology Providers

Purpose: Performance-based payments to oncology providers participating in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM) are based, in part, on overall spending in 6-month episodes of care, including spending unrelated to oncology care. The amount of spending likely to occur outside of oncologists’ purview is unknown. Methods: Following the OCM definition of an episode, we used SEER-Medicare data from 2006 to 2013 to identify episodes of cancer care for the following diagnoses: breast cancer (BC), non–small-cell lung cancer, renal cell carcinoma, multiple myeloma (MM), and chronic myeloid leukemia. Claims were categorized by service type and, separately, whether the content fell within the purview of oncology providers (classified as oncology, with all other claims nononcology). We calculated the shares of episode spending attributable to oncology versus nononcology services. Results: The percentage of oncology spending within OCM episodes ranged from 62.4% in BC to 85.5% in MM. The largest source of oncology spending was antineoplastic drug therapy, ranging from 21.8% of total episode spending in BC to 67.6% in chronic myeloid leukemia. The largest source of nononcology spending was acute hospitalization and inpatient physician costs, ranging from 6.6% of overall spending for MM to 10.4% for non–small-cell lung cancer; inpatient oncology spending contributed roughly similar shares to overall spending. Conclusion: Most spending in OCM-defined episodes was attributable to services related to cancer care, especially antineoplastic drug therapy. Inability to control nononcology spending may present challenges for practices participating in the OCM, however.

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