After analyzing data about risk of death and emergency department usage for its cancer patients, Northwest Medical Specialties opened a walk-in clinic.
A nurse practitioner staffs the clinic, which is open from 9 a.m. to 5 p.m. on weekdays. The goal is to treat the acute symptoms that cancer patients experience—such as pain, dizziness, and diarrhea—and avoid trips to the emergency department.
The practice—with six locations in the Tacoma, Washington area—plans to hire a second advanced practice provider to staff the acute-care service at a second location.
Before launching the clinic, the practice conducted a six-month pilot, demonstrating sufficient patient demand and satisfaction with the service to justify the cost.
“This was an example of a practice transformation—of how this practice took information and made a dramatic change in the clinic,” says Sibel Blau, MD, medical director, hematology and oncology divisions at the 10-physican practice. The overall goal, she says, is to position the practice for success under value-based reimbursement models.
Northwest Medical Specialties is not alone. As value-based payment arrangements become more common, community cancer providers are installing data-analysis tools to help them figure out how to meet cost and quality targets.
Payers and providers are focusing on improving the quality and efficiency of cancer care because of the disease’s prevalence and treatment costs. The American Cancer Society projects that there will be more than 1.7 million new cancer cases and 606,880 cancer deaths in the United States in 2019.
The costs to treat those patients keep rising. The National Institutes of Health estimates that the United States will spend at least $158 billion on cancer care in 2020, a 27% increase over expenditures in 2010.
Because a significant proportion of those patients are Medicare beneficiaries, CMS developed a five-year pilot project, the Oncology Care Model (OCM), which began on July 1, 2016. Nearly 200 physician groups and 17 commercial payers are participating in the program, according to CMS.
CMS reimburses providers based on their performance during six-month episodes of care for chemotherapy treatment using either a one-sided or a two-sided risk model.
West Palm Beach, Florida-based Integra Connect, which develops information technology solutions for healthcare providers, has tracked the performance of its customers involved in the OCM program, which totals about 16 practices and 1,000 oncologists. “What we see is a steady improvement,” says Charles Saunders, MD, CEO, Integra Connect. With each successive performance period, more of the practices have kept their actual costs of care under the target cost set by CMS, he says.
Nonetheless, Saunders says some of his clients did not earn a bonus payment during any of four performance periods, ending with the first half of 2018. Those practices would have decided by December 2019 whether to accept two-sided risk, or drop out of the program.
In cancer care, the largest buckets of costs are chemotherapy and other medications; facility services, such as hospitals and skilled nursing facilities; and care at the end of life, says Saunders, who regularly writes and speaks about value-based cancer treatment.
CMS isn’t the only payer applying value-based care models to cancer treatment. In April, Humana announced its value-based program for oncology in which it will reward oncology practices for exceeding quality and cost benchmarks over a one-year period.
Like Northwest Medical Specialties, Texas Oncology—a large cancer treatment and research provider in Texas specializing in hematology, pediatric and radiation oncology, which also participates in CMS’ OCM—has worked to decrease rates of hospital admissions and emergency department visits.