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A value-based cancer care model focuses on better aligning providers with health plans and employers through an IPA.
A new value-based cancer care model is focusing on better aligning providers with health plans and employers through an independent practice association (IPA) structure that creates patient-centered medical homes.
The Vantage Cancer Care Network (VCCN) model, launching in Philadelphia, is already under way with the establishment of an IPA that is being advised by John Sprandio, Sr, MD, FACP, a practicing medical oncologist and hematologist and an innovator for the Oncology Patient-Centered Medical Home. More than 60 oncologists in seven locations from the Philadelphia area are now participating in VCCN’s Philadelphia-based network, and more than 30 patients are participating. It’s anticipated that 750 patients will participate by the end of 2016.
“It is a model that ensures the best outcome, minimizing side effects at a lower overall utilization of services,” John Iacuone, MD, MBA, president and chief clinical officer, VCCN. “Typically this results in a lower overall cost to the patient and payer, while providing shared savings with the physician managing the patient.”
In Philadelphia, VCCN has formed a single specialty IPA of oncologists who have contracted with a payer in the market to share savings.
“We are monitoring outcomes, quality of life, and access to care as part of our commitment to the payer that its patients will be receiving comparable or exceptional care-value-while reducing inappropriate utilization of services,” Iacuone says.
For example, VCCN’s IPA oncologists may be managing a patient who has received cancer treatment and has some vomiting not controlled with their current medications.
“Traditionally, the patient would go to the emergency department and have a 50% chance of being admitted,” he explains. “In our value-based model, we utilize oncology-specific symptom management tools and this patient would call the oncologist office, even after hours, and our providers would follow our symptom management decision tree that-for the sake of argument-would have resulted in changing medications, and a next-day appointment in the office, avoiding a very costly and avoidable admission to the hospital.”
The Oncology Medical Home helps ensure the delivery of quality and value in cancer care.
“When a patient is diagnosed with cancer, typically they are managed during the entire treatment period by a medical oncologist,” Iacuone says. “That physician coordinates all aspects of care including conditions that aren’t directly related to cancer-for example, COPD or congestive heart failure-thus a medical home model specific to cancer patients and their oncologists.”
Cancer patients have an opportunity with an intense team-based approach to overcome this disease, according to Iacuone. “Making critical, value-based care management decisions is the purview of the oncologist,” he says. “A value-based contract allows the oncologist to manage the patient, and with different incentives for utilization of services, the health plan is protected from potentially harmful overutilization of services. It’s a win for the patient, the oncologists and the payer, and at the same time reducing our out-of-control healthcare expenditures for Americans.”
The Philadelphia model has only been “live” for less than six months and while it is too to be able to report outcomes, preliminary data show excellent and timely access to providers, and strong compliance with utilization of value-based treatment guidelines based on National Comprehensive Cancer Network Guidelines, according to Iacuone.
Next: The payment paradigm
Providers, payers and patients work together to partner with value-based providers in the network to change the paradigm regarding payment, Iacuone says.
“Providers and patients are now incentivized to avoid unnecessary and costly utilization to manage their cancer that do not improve outcomes, reduce toxicity or improve quality of life for the patient,” he says. “Historically, providers have been paid when they utilize services, for example, order a test, prescribe a medicine, or perform surgery. This is bankrupting Medicare and patients due to unsustainable inflation of healthcare costs that may have unproven, or limited improvement or value. This is happening in cancer care as well, but at twice the inflation rate of all other healthcare services.
“[Payers] cannot continue to subsidize the rates of increases in healthcare, and the citizens can’t afford healthcare insurance for their families,” Iacuone says. “It is known that there is significant opportunity to reduce healthcare expenditures without sacrificing excellent outcomes, and quality of life while reducing costs. This doesn’t happen now because providers do not get reimbursed or incentivized to avoid unnecessary utilization [e.g., avoid an unnecessary hospitalization or readmission by having extended office hours, etc.]. CMS has stated that it has “set a goal of tying 30% of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50% by 2018.”
VCCN is a part of McKesson Specialty Health.
More discussion on value-based cancer care will take place at the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting in Chicago, June 3-7.