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Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
CEO of a Pennsylvania-based oncology group shares how participating in a new value-based model is changing the care approach.
Receiving a cancer diagnosis can be a stressful experience not only for the patient, but their family members. In addition to the shock of receiving the diagnosis, patients may also be concerned about their financial obligations regarding their treatment plan.
That’s why Bensalem, PA-based Alliance Cancer Specialists provides patients and family members with access to a social worker (who is imbedded at one of the oncology group’s 11 practices) to help them navigate through their emotional journey and the financial impacts of oncology treatment, says Ann Marie Edwards, CEO.
This social worker is funded through the group’s participation in CMS’ oncology care model.
Under this model, physician practices have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. CMS is also partnering with commercial payers in the model.
Another benefit of its involvement in CMS’ oncology care model is the practice has access to data-although “it’s usually about a quarter behind”-on its patients’ total cost of care.
This information allows the oncology group to identify its highest-cost patients and work to curb some of those costs. For example, it can focus more efforts on helping certain patients avoid emergency room visits, she says.
Edwards notes that Alliance Cancer Specialists also receives data feeds from Philadelphia’s HealthShare Exchange, a regional health information exchange (HIE) that links the EHRs of different hospitals and health systems, medical centers, and clinics, in addition to claims data from payers.
These data feeds include real-time updates when one of the oncology group’s patients presents at a regional hospital emergency room, when the patient is discharged, and if the patient is going to a rehabilitation facility.
In the future, Edwards would like this information to flow directly from the regional HIE to the practice’s EHR. For now, her group uses a population health platform from Piscataway Township, NJ-based HealthEC that sends e-mail notifications to Alliance Cancer Specialists when its patients experience a healthcare-related event.
Data about discharge and care transition episodes allows the oncology group to know when its patients return home from the hospital or if they’re going to a rehabilitation facility, which triggers Edwards’ team members to contact patients and get them into the practice for follow-up care.
Edwards has been unsuccessful at getting private payers to work with the group on value-based contracts.
Here are three reasons she says private payers should be interested in partnering with community oncology practices on value-based care contracts:
1. Community oncology settings are lower-cost settings of care, when compared to cancer centers that are being acquired by hospital networks, where the cost of care will likely increase, she says. That’s particularly the case in Philadelphia, adds Edwards, “where everybody is being bought by hospitals.”
2. More proactive information between community practices and payers will lead to savings. “Without sharing data, no one can bend the cost curve in healthcare,” she says. “We can’t just cut costs, we have to manage care. Managing care just means focusing the care on the patients who need it the most. And those patients who are leaking out of the system, who are going out of network … the only way for us to know that is to be exchanging information with payers.”
3. Value-based care can also help retain members. “Creativity is required for payers that want to engage in high-cost diseases,” says Edwards. “It’s not by bundling the total cost but by lowering cost while giving patients value that will retain members.”