Patient Navigation in Cancer: The Business Case to Support Clinical Needs

PURPOSE: Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits. METHODS: Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN. RESULTS: In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover. CONCLUSION: PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.

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Making the (business) case for outpatient and home-based palliative care for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.266 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 266-266

Author(s):

Brian Cassel ◽

Kathleen Kerr ◽

Egidio Del Fabbro

Keyword(s):

Palliative Care ◽

Population Health ◽

Health Management ◽

Cost Effective ◽

Business Case ◽

Inpatient Setting ◽

Fee For Service ◽

Patient Centered ◽

Community Based ◽

Home Based

266 Background: Randomized controlled trials by Temel (2010) and Brumley (2003, 2007) have demonstrated the positive clinical, psycho-social, and utilization impact of providing early clinic or home-based palliative care (PC) concurrently with standard disease-focused treatment. Despite clear benefits, the growth of outpatient PC has been constrained by lack of clarity about the “business case” for hospitals or health systems to develop and fund PC services outside the inpatient setting. Methods: We will present findings from Virginia Commonwealth University (VCU) that provide a compelling quantification of the risks for hospitals to continue “business as usual” in this changing environment. Our approach measures quality, quantity, and costs of care for patients with cancer over a period of 6-12 months prior to death. Performance on some of these measures impact revenues in the prevailing fee-for-service reimbursement model; others are utilized in national, public ratings of quality; and still others influence organizational ability to compete in the population health management model that rewards quality and efficiency over time. Results: We used these data to highlight VCU Health System’s exposure to financial risks to create a strong business case for outpatient palliative care in which patient-centered and hospital-centered outcomes are aligned. This approach elevated our proposal to be included in a broader strategic initiative by our health system to manage complex care more efficiently, and to manage population health more proactively. Our analytic approach was then replicated by a diverse group of California provider groups who adopted or adapted the VCU model to advance their community-based palliative care programs as part of the California Health Care Foundation’s “Palliative Care Action Community” initiative. Conclusions: Our analytic model and articulation of the business case for community-based palliative care can help others to create and sustain quality-driven, patient-centered, cost-effective PC programs in their own institutions.

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Patient-Centered Medical Homes in Community Oncology Practices: Changes in Spending and Care Quality Associated With the COME HOME Experience

Journal of Oncology Practice ◽

10.1200/jop.18.00479 ◽

2019 ◽

Vol 15 (1) ◽

pp. e56-e64 ◽

Cited By ~ 10

Author(s):

Teresa M. Waters ◽

Cameron M. Kaplan ◽

Ilana Graetz ◽

Mary M. Price ◽

Laura A. Stevens ◽

...

Keyword(s):

Emergency Department ◽

Medical Home ◽

Similar Rate ◽

Care Quality ◽

Emergency Department Visits ◽

Fee For Service ◽

Patient Centered ◽

Home Program ◽

Medical Spending ◽

Community Oncology

PURPOSE: We examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality. PATIENTS AND METHODS: We compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for clinical and sociodemographic differences. Our primary outcome was 6-month medical spending per beneficiary. Secondary outcomes included 6-month out-of-pocket spending, inpatient and ambulatory care–sensitive hospitalizations, readmissions, length of stay, and emergency department and evaluation and management visits. RESULTS: Before COME HOME, 6-month medical spending was $2,975 higher for the study group compared with controls (95% CI, $1,635 to $4,315; P < .001) and increasing at a similar rate. After intervention, this difference was reduced to $318 (95% CI, −$1,105 to $1,741; P = .661), a significant change of −$2,657 (95% CI, −$4,631 to −$683; P = .008) or 8.1% savings relative to 6-month average spending ($32,866). COME HOME was also associated with significantly reduced (10.2 %) emergency department visits per 1,000 patients per 6-month period ( P = .024). There were no statistically significant differences in other outcomes. CONCLUSION: COME HOME was associated with reduced Medicare spending and improved emergency department use. The patient-centered medical home model holds promise for oncology practices, but improvements were not uniform.

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Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study

OTO Open ◽

10.1177/2473974x211015937 ◽

2021 ◽

Vol 5 (2) ◽

pp. 2473974X2110159

Author(s):

Victoria Kuta ◽

David Forner ◽

Jason Azzi ◽

Dennis Curry ◽

Christopher W. Noel ◽

...

Keyword(s):

Decision Making ◽

Thyroid Nodules ◽

Management Decision ◽

Molecular Testing ◽

Fee For Service ◽

Hospital Type ◽

Patient Centered ◽

Cross Sectional ◽

Payment Model ◽

Nodule Size

Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.

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The effects of telehealth use for post-acute rehabilitation patient outcomes

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16686771 ◽

2016 ◽

Vol 24 (3) ◽

pp. 179-184 ◽

Cited By ~ 2

Author(s):

Stephanie A Hicks ◽

Verena R Cimarolli

Keyword(s):

Cognitive Functioning ◽

Patient Outcomes ◽

Skilled Nursing Facility ◽

Functional Independence ◽

Emergency Department Visits ◽

Nursing Facility ◽

Skilled Nursing ◽

Rehabilitation Care ◽

Acute Rehabilitation ◽

The Impact

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

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828. Evaluation of Home Time as a Patient-Centered Metric for Pneumonia Hospitalizations: A Retrospective Cohort Study of Medicare Fee-For-Service Beneficiaries

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1017 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S455-S456

Author(s):

Rajeshwari Nair ◽

Yubo Gao ◽

Mary Vaughan-Sarrazin ◽

Eli N Perencevich ◽

Saket Girotra ◽

...

Keyword(s):

Performance Metrics ◽

Care Delivery ◽

Care Facility ◽

Hospital Performance ◽

Policy Implications ◽

Fee For Service ◽

Multilevel Regression ◽

Hospital Level ◽

Post Discharge ◽

Patient Centered

Abstract Background The Centers for Medicare & Medicaid Services (CMS) uses hospital readmission to incentivize hospital care delivery for acute conditions including pneumonia. However, current CMS performance metrics do not account for the competing risk of mortality in the post-discharge period or during the hospital stay. Our objective was to assess home time within 30 days after discharge among pneumonia hospitalizations, as a patient-centered metric. Methods A retrospective observational study was conducted in a cohort of Medicare fee-for-service beneficiaries admitted between 01/01/2015 and 11/30/2017. Home time was the number of days spent alive, out of an acute care setting, skilled nursing facility, or a rehabilitation facility within 30 days of discharge. If a patient spends any part of a day in a care facility or died after discharge, then that day was not included in the calculation for home time. Hospital-level rates of risk-adjusted home time were calculated using multilevel regression models. We compared hospital performance on 30-day risk-standardized home time with its performance on 30-day risk standardized readmission rate (RSRR) and mortality rate (RSMR). Characteristics of hospitals with high and low risk-adjusted home-time were compared. Results Among 1.7 million pneumonia admissions admitted to 3,116 hospitals, the median 30-day risk-standardized home time was 20.5 days (interquartile range: 18.9-21.9 days). Hospital-level characteristics such as case volume, bed size, for-profit ownership, rural location of hospital, teaching status, and participation in the bundle payment program were significantly associated with home-time. RSRR (rho: -0.233, p< 0.0001) and RSMR (rho: -0.223, p< 0.0001) had weak, inverse correlations with home time. Using the home time metric, 35.5% of hospitals were reclassified as high performers compared with their average or poor performance on the RSRR or RSMR metric. Conclusion Home time is a novel, patient-centered, hospital-level metric that can be easily calculated using claims data, accounts for differences in post-discharge mortality and can be intuitively interpreted. Utilization of this metric could potentially have policy implications in assessing hospital performance on delivery of healthcare to pneumonia patients. Disclosures Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)

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Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

Clinical Chemistry ◽

10.1373/clinchem.2014.232629 ◽

2015 ◽

Vol 61 (4) ◽

pp. 589-599 ◽

Cited By ~ 33

Author(s):

Mike J Hallworth ◽

Paul L Epner ◽

Christoph Ebert ◽

Corinne R Fantz ◽

Sherry A Faye ◽

...

Keyword(s):

Patient Outcomes ◽

Clinical Effectiveness ◽

Laboratory Medicine ◽

Current Evidence ◽

Patient Centered ◽

Definition Of ◽

Current Utilization ◽

Measures Of Effectiveness ◽

The Impact ◽

Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

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Patient Centered Medical Home transformation at an academic medical center

Journal of Hospital Administration ◽

10.5430/jha.v5n1p34 ◽

2015 ◽

Vol 5 (1) ◽

pp. 34

Author(s):

Randy Wexler ◽

Jennifer Lehman ◽

Mary Jo Welker

Keyword(s):

Family Medicine ◽

Patient Outcomes ◽

Medical Home ◽

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Patient Centered Medical Home ◽

Model Of Care ◽

Patient Centered ◽

Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

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Social and Medical Determinants of Cardiometabolic Health: The Big Picture

Ethnicity & Disease ◽

10.18865/ed.25.4.521 ◽

2015 ◽

Vol 25 (4) ◽

pp. 521 ◽

Cited By ~ 27

Author(s):

Gary A. Puckrein ◽

Brent M. Egan

Keyword(s):

Emergency Department ◽

Health Disparities ◽

Social Determinants ◽

The United States ◽

Emergency Department Visits ◽

Cardiometabolic Health ◽

Years Of Life Lost ◽

Fee For Service ◽

Cardiometabolic Diseases ◽

Mean Cost

<p class="Pa7">Cardiometabolic diseases, including diabetes and heart disease, account for >12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental factors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hypertension, and Blacks are four times more likely than Whites to live in lowest SES neighborhoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk factors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interventions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbalance greater disease susceptibility. Place-based interventions on social and medical determinants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks. <em>Ethn Dis. </em>2015;25(4):521-524; doi:10.18865/ ed.25.4.521</p>

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An Overview on Patient-Centered Clinical Services

Borneo Journal of Pharmacy ◽

10.33084/bjop.v4i2.1978 ◽

2021 ◽

Vol 4 (2) ◽

pp. 157-170

Author(s):

Gaurav Joshi ◽

Atul Kabra ◽

Nishant Goutam ◽

Alka Sharma

Keyword(s):

Patient Outcomes ◽

Clinical Pharmacist ◽

Healthcare Systems ◽

Clinical Services ◽

Drug Related Problems ◽

Patient Centered ◽

Health Quality ◽

Health Quality Of Life ◽

The One

Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.

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The Role of Patient Navigators in Ambulatory Care: Overview of Systematic Reviews

10.21203/rs.3.rs-506357/v1 ◽

2021 ◽

Author(s):

Hannah Budde ◽

Gemma Williams ◽

Juliane Winkelmann ◽

Laura Pfirter ◽

Claudia Bettina Maier

Keyword(s):

Health Services ◽

Health System ◽

Ambulatory Care ◽

Systematic Reviews ◽

Patient Navigation ◽

Transitional Care ◽

Emergency Department Visits ◽

Patient Navigators

Abstract Background: Patient navigators have been introduced across various countries to enable timely access to healthcare services and ensure completion of diagnosis and follow-up of care. There is an increasing amount of evidence on the positive effect of patient navigation for patients. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes.Methods: An overview of reviews was conducted, based on a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed all roles of patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers as well as lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous data collection was performed in multiple data bases. After reaching an inter-rater agreement, title and abstract screening was independently performed. Of an initial 8362 search results a total of 673 articles were eligible for full-text screening. An extraction form was used to analyse the nine included review.Results: Nine systematic reviews were included covering various patient navigation roles in cancer care, disease screening and transitional care. Seven systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Six reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes and hospital readmission rates and mixed evidence on quality of life and emergency department visits.Conclusions: Patient navigators have shown to expand access to screenings and health services for vulnerable patients or population groups who tend to underuse health services.

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