Oncology Patient-Centered Medical Home Oncology Management Services, Inc

Oncology Patient-Centered Medical Home Oncology Management Services, Inc

Oncology Patient-Centered Medical Home Oncology Management Services, Inc Building the Business Case for Quality and Value John D. Sprandio, MD, FACP October 3, 2014 Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Patient-Centered Medical Home 1967 Standards of Child Health Care American Academy of Pediatrics 2007 Joint Principles of the PCMH American Medical Association American Association of Family Practitioners American Academy of Pediatrics American College of Physicians American Osteopathic Association Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

Joint Principles of PCMH 1. Personal physician coordinates comprehensive care. 2. Physician directed medical team. 3. Whole person orientation for all stages of life (acute, chronic, preventive, and end-of-life care). 4. Coordinated and integrated care across all aspects of the health care system utilizing information technology. 5. Quality and safety with continuous quality improvement and recognition by a non-governmental body. 6. Enhanced access through open scheduling and new communication tools. 7. Appropriate payment recognizing the added value with the model. Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology NCQA Primary Care Recognition Six Standards (validated, tested elements & features) 1. Enhanced Access and Continuity 2. Identify and Manage Populations 3. Plan and Manage Care 4. Provide Self-care Support and Community Resources 5. Track and Coordinate Care 6. Measure and Improve Performance

www.ncqa.org Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Medical Neighborhood American College of Physicians Council of Subspecialty Societies (CSS), Policy Paper 2010 Addressed relationship between primary care PCMH model and specialty/ subspecialty practices Highlights: Established definition of Patient Centered Medical Home Neighbor Approved a framework to categorize interactions between PCMH and PCMH - N Approved guiding principles of the development of care-coordination agreements between PCMH and PCMH-N Neil Kirschner, Ph.D. American College of Physicians, Senior Associate Regulatory and Insurer Affairs Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Quality and Cost are Completely Intertwined Quality:

The degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM 1997) Cost: Resource utilization related to delivery of care Value: The degree to which health services increase the likelihood of desired health outcomes, are consistent with current professional knowledge AND are delivered with the proper allocation of resources The utilization of unnecessary resources IS poor quality of care Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Value in Cancer Care Evidence based care Q V= C

NCCN guidelines COC program certification ASCO QOPI certification IOM reports 1997-2013 Desired outcomes Treatment Guideline adherence Appropriate therapy rendered Rational & Informed care at EOL 7 Doing Well by Doing Good: Improving the Business Case for Quality Gosfield, Reinertsen, et al. 2003 *2010 Update Care Team engagement essential in driving quality Centrality of the care team-patient relationship: Clinical team provides 1-on-1 interaction that defines healthcare Explanation, prediction, plan of care Physicians and advanced practitioners have the broadest scope of professional jurisdiction Drive provision of all goods and services The Care team is the portal to the rest of the system Referrals, education, interpretation of insurance benefits Care Team members face barriers on their way to becoming accountable for the quality and consistency of care they deliver

Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Doing Well by Doing Good: Improving the Business Case for Quality Gosfield, Reinertsen, et al. 2003 *2010 Update Barriers to quality = Care Team time stealers EMR, work-flow, niche competitors, documentation & communication hurdles. Variable: data collection, data presentation, decision support, outcome measures. Absence of real-time performance measurement, efficiency tools, and payer support. Care Team work environment redesign Standardize Simplify Make clinically relevant Engage patients Fix accountability at the locus of control Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology

Creating Value Care Team Work Environment 2003 Addressing barriers to consistency and accountability Standardization of oncology processes Value Proposition Scalability Payer Response Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Enhancing Value in Cancer Care Q V= C Addressing Care Team Barriers Streamline processes Standardize roles & responsibilities Minimize clinically irrelevant activity

Improve patient/family engagement Fix accountability at locus of control Data systems tracking performance Continuously improve performance Treatment Guideline adherence Appropriate therapy rendered Rational & Informed care at EOL Enhanced patient access Improved patient navigation, coordination & communication Reduced avoidable complications Reduced unnecessary utilization 11 Oncology Patient-Centered Medical Home NCQA level III, PCMH recognition April 2010 Integrated care delivery model for hematology & oncology PCMH principles: access, engagement, shared decisions,

coordination, communication and accountability Medical oncology serves as the hub of coordination and accountability in meeting cancer care needs Integrates Primary PCMH, surgical, radiation oncology, inpatient, social, hospice services via information hub Value Proposition: Better cancer care, health, lower cost Payer recognition, integration with ACOs, Clinically Integrated Networks Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology PCMH Quality & Value Driver Diagram Triple Aim Primary Driver Secondary Drivers Patient-,Payer-,and Provider-Centered Care Team Environment Delivery Standards Outcomes Services

Process of Care Standards, Care Integration, Evidence Base Multi-disciplinary Guideline Concordance Engagement & Orientation Patient & Family Experience of Care Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Survivorship Care Standardized Primary PCMH End of Life Care Hospice Enrollment

Place at Time of Death Resource Utilization Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements

Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Physicians PCMH-N Patient Advocacy NCCS, CSC, ACS American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN NCCN Treatment Guidelines Survivorship Guidelines

ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Payer Payer Based Based Episode Episode and and OMH Programs OMH Programs CMS CMS && Commercial Commercial 2014 Oncology Management Services, Ltd . Creating Value

Care Team Work Environment Standardization of oncology care processes Value Proposition Scalability Payer Response Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Consistent approach by the care team Not for redistribution. Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination

Symptom Management Survivorship Care Goals of therapy 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Define role of nurse and patient navigators, physicians, etc Modes of enhanced access & coordination defined Financial counseling details of insurance coverage Patient reporting & practice responsibilities Practice as Point of First Triage

Symptom and disease management strategies (nurse triage) Patient Portal education Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Lay Navigators Scheduling of all imaging, laboratory testing

Precertification of necessary imaging Scheduling all external provider appointments Oncologic and non-oncologic Tracking test results and consultation reports to completion Re-scheduling when necessary Interface/scanning of reports Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes

Standardized Engagement & Orientation Patient Navigation Shared Decision-Making Explanation specific TNM & molecular staging Prediction natural history, impact on performance status Treatment options consensus based guidelines Financial counseling patient OOP expenses Patient Preferences life goals, family responsibilities, hobbies Plan of Care discussed and mutually agreed upon Goals of therapy defined curative or palliative Written or electronic plan shared with patient/stakeholders Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy Not for redistribution. 2013 Oncology Management Services,

Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Standardized outpatient processes and work flow Patient self assessment questionnaire (PSAQ) Data collection and presentation drives decisions Adherence to multidisciplinary and chemotherapy guidelines Navigation, communication & coordination of all aspects of care Provider team accessibility Performance metrics monitored Care coordination Symptom Management Survivorship Care Goals of therapy Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology

Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Multidisciplinary input Primary, Surgery, Radiation, Medical Oncology Timeline of intervention discussed and scheduled Standardized communication among primary care & oncology teams Coordination of care between oncologist, primary and other specialists Coordination of care arrangements define responsibilities (PCMH-N) Transitions of care OP to ER or Admission, admission to OP Symptom Management Survivorship Care Goals of therapy

Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom management during and between OP visits Standardized symptom data collection, grading & documentation Auto-populated fields in documentation driving physician response Longitudinal view of success of symptom management Documentation of specific recommendations shared with patient Telephone triage 24/7 - standardized algorithms Documentation of type and disposition of every call Survivorship Care

Goals of therapy Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Consistent & Coordinated Care Plans Progress note templates integrated into software overlay Assessment & Survivorship Care Plan Coordination agreements with primary care team (ACP PCMH-N) Dissemination of information to all involved providers Enhanced patient interaction with community support services

Goals of therapy Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Standardized Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy Performance Status driven decision making in non-curative setting Standardized PS measurement

Documentation of ongoing goals dialogue based on PS changes Goals of therapy updated via replay of: Explanation, Prediction, Options, Patient Preference, Plan of Care Hospice utilization monitored Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Creating Value Care Team Work Environment Process standardization Value Proposition demonstration of results Scalability Payer Response Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Outcome of Clinical Nurse Triage Phone Calls in 2013

n = 5106 clinical phone calls Manage Symptom(s) at home; 84.21% Referred to Primary/Specialist; 5.35% Go to 3.47% nearest ER; 2.39% Office visit tomorrow; Office visit today; 3.96% Pt sent for Radiographic Study; 0.41% Chemo Suite Intervention; 0.22% 7.43% of patients were seen in the office within 24 hours of call Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology ER Eva lu a tio n s p e r ch e m o th e ra p y p a tie n t p e r ye a r Average emergency room (ER) Evaluations per chemotherapy patient per year (APCPPY) for the CMOH patie nt population , 2004 -2013. 3.000

2.600 2.567 USON/Milliman: Approximately 2 emergency room visits per chemotherapy patient per year 2.500 2.067 (14 million commercially insured; 104,473 cancer patients) Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009 2.000 1.604 1.500 1.273 1.119 0.910 1.000 0.818 0.703 0.550 0.500

0.000 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year Not for redistribution. 2013 Oncology Management Services, 2014 Oncology

Management Services, Consultants in Medical&Oncology & Hematology Consultants in Medical Oncology Hematology Average Admissions per Chemotherapy Patient Per Year (APCPPY) for CMOH patient population, 2007-2011 1.200 1.080 USON/Milliman: Approximately 1 hospital admission per chemotherapy patient per year (n=14 1.055 million commercially insured; 104,473 cancer patients) 1.000 Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009 APCPPY 0.876 0.800 0.694

0.605 0.600 0.562 0.528 0.400 0.200 0.000 2007 2008 2009 2010 2011 2012 2013 Multimodality Guidelines NCCN multimodality care plans

Consensus based recommendations Physician selects care plan within EMR Selection shared with billing, nursing staff NCCN Chemotherapy Guideline Compliance Adjuvant and first line metastatic Adherence > 95% 2007 2013 (CMOH) Practice and individual physician performance Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology PCMH Palliative Care Concurrent delivery of palliative care Comprehensive health assessment each visit Symptoms: patient defined, RN/MA confirmed, physician accountable to respond NCI graded and longitudinally viewed Dynamic problem list of symptoms, co-morbid conditions Documentation of ongoing management Use of standardized approaches and instructions Patient view of documentation via portal Not for redistribution. 2014 Oncology Management Services,

Consultants in Medical Oncology & Hematology Oncology PCMH End of Life Care Performance Status Driven Decision-Making PS: patient defined, RN/MA documentation, physicians accountable to respond PSAQ, ECOG grading (fixed), physician prompt PS longitudinally viewed by patient and physician Physician accountability Systems that monitor for changes in PS (ECOG 3) Documentation of rationale for continuation of therapy Transparency of discussion of goals Patient visibility of documentation via portal Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology PCMH Survivorship Care Care team: NP/PA + physician collaboration

Survivorship care plan templates (ASCO) Clinical summary (toxicities, co-morbidities) Documentation of management of residual symptoms Treatment summary, genetic testing, family history Surveillance and screening activities, immunizations Community resource utilization Coordination of care arrangements in survivorship Responsibility matrix defined Primary PCMH, Oncology PCMH, Radiation and Surgical teams Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology PCMH Transitions of Care Transition responsibility: facilitating hand-offs Symptomatic patients with an apparent new malignancy from ER, Primary PCMH or specialist office Oncology team drives efficiency, shortening timeline to diagnosis, symptom control and treatment Symptom control = reduced unnecessary ER visits, admission From oncology office to ER or inpatient admission Transfer of information to accepting parties Notification to Primary PCMH team

From acute care to outpatient or skilled care Scheduling of all testing, consultation and follow-up visits Notification to Primary PCMH team Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Creating Value Care Team Work Environment Process standardization Value Proposition Scalability Payer Response Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Scalability of Model Address care team barriers (Readiness Assessment)

Process and technology framework: merging work-flow, data collection/presentation, documentation, communication Standards, elements and features of care processes Oncology specific (NCQA, COC, TJC) Internal feedback of relevant practice performance data Knowledge driven continuous improvement Payer Response Alternate Payment Methods Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology PCORI-NCQA-ASCO-OMS PCORI funded Oncology Project (SEPA) NCQA, OMS, ASCO, RAND, NCCS, IBC PCSP Recognition PCOC Recognition Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Patient-Centered Specialty Practice (PCSP)

1. Track & Coordinate Referrals A. Referral Process and Agreements (MP) B. Referral Content C. Referral Response (MP) 4. Plan & Manage Care A. Care Planning and Support Self-Care B. Medication Management (MP) C. Use Electronic Prescribing 2. Provide Access & Communication A. B. C. D. Access Electronic Access Specialty Practice Responsibilities Culturally and Linguistically Appropriate Services E. The Practice Team (MP) 3. Identify & Coordinate Patient Populations A. Patient Information B. Clinical Data D. Coordinate Patient Populations Not for redistribution.

5. Track & Coordinate Care D. Test Tracking and Follow-Up E. Referral Tracking and Follow-Up F. Coordinate Care Transitions 6. Measure & Improve Performance G. Measure Performance H. Measure Patient/Family Experience I. Implement and Demonstrate Continuous Quality Improvement (MP) J. Report Performance K. Use Certified EHR Technology 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Patient-Centered Oncology Care (PCOC) 1. Track & Coordinate Referrals A. Referral Process and Agreements (L) B. Referral Content (L) C. Referral Response (M) 4. Plan & Manage Care A. Care Planning and Support Self-Care (H) B. Medication Management (H) C. Use Electronic Prescribing (L) 2. Provide Access & Communication

A. B. C. D. Access (H) Electronic Access (L) Specialty Practice Responsibilities (M) Culturally and Linguistically Appropriate Services (CLAS) (L) E. The Practice Team (H) 3. Identify & Coordinate Patient Populations A. B. C. D. E. Patient Information (M) Clinical Data (L) Comprehensive Health Assessment (H) Coordinate Patient Populations (L) Evidence-based Decision Support (H) 5. Track & Coordinate Care D. Test Tracking and Follow-Up (L) E. Referral Tracking and Follow-Up (M) F. Coordinate Care Transitions (H)

6. Measure & Improve Performance A. Measure Performance (L) B. Measure Patient/Family Experience (L) C. Implement and Demonstrate Continuous Quality Improvement (M) D. Report Performance (L) E. Use Certified EHR Technology (L) Element Priority: Low (L); Medium (M); High (H) Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Creating Value Care Team Work Environment Process standardization Value Proposition Scalability Payer Response Not for redistribution.

2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Payment Reform PCORI funded Oncology Project (SEPA) NCQA, OMS, ASCO, RAND, NCCS, IBC CMS Oncology Payment Reform TEP MITRE, Brookings, RAND, CMS, CMMI Oncology Bundled Payment Consortium CAP, CMS, CMMI, multiple payers ASCO Payment Reform Initiatives OMS CMOH Alternate Payment Methods in SEPA IBC, Keystone First, (48% of patients) Not for redistribution. 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Provider Ability & Accountability Payment Reform for cancer care Episode or Budgeted FFS

Not for redistribution. Pathways OPCMH Payment model 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology CMS Oncology Care Model (OCM) Combined features of CMS Oncology Payment Reform TEP + CAP Bundled Payment Consortium Medical oncology treatment episodes - broadly applied PCMH Practice Transformation Patient Navigators Enhanced Coordination Structured Care Plan (IOM)

24/7 access to clinician with records Adherence to nationally recognized treatment guidelines Oncology specific EHR, stage 2 MU by end of year three Data driven quality improvement program Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology CMS Oncology Care Model (OCM) Performance Metrics reported quarterly Driven by Care Team execution of PCMH processes ER visits/Hospital admissions (episode + 6 months & EOL) CAHPS (oncology version) Comprehensive health assessment, including PS

Psychological screening (once/episode) Palliative care (concurrently or via formal consultation) Transition coordination and follow-up testing/OP visits Medication reconciliation Pain management Hospice Utilization Resource Utilization (Drugs, radiation therapy, imaging, laboratory) Results of data driven quality improvement efforts Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Principles of PCMH-N Applied to Cancer Care PCMH standards + supportive technology applied to primary and specialty care enables a neighborhood of practices that deliver what Don Berwick called for in 2012: . an electronic line-of-sight contact with each other all day long, weaving a net of help and partnership with patients and families. Not for redistribution. 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

Recently Viewed Presentations

  • Film Techniques - English Resources

    Film Techniques - English Resources

    High Angle. Eye Level Angle. Low Level Angle. Dutch Angle. Eye level Angle :: positioned at eye level with subject. Purpose? To show the subject as they really are, or encourage us to think of them as honest, good natured...
  • Thyroid and Anti-Thyroid Drugs - جامعة الملك سعود

    Thyroid and Anti-Thyroid Drugs - جامعة الملك سعود

    Treatment of Hyperthyroidism Drugs thioureylenes iodides radioactive iodine beta adrenoceptor blocking agents 'Lugol's iodine Surgical Subtotal Thyroidectomy 1-Anti-thyroid drugs—Thioureylenes Inhibits thyroid hormone synthesis by irreversibly binding to TPO inhibiting its ability to break down iodine (I2→I-) and covalently attach it...
  • Highlights of the AUA - Brazil Basic Sciences

    Highlights of the AUA - Brazil Basic Sciences

    Highlights of the AUA - Brazil Basic Sciences Jennifer Bishop, Ph.D. Bladder Cancer Peter Black, MD, FACS, FRCSC Umberto Capitanio, MD Timothy Chang, MD Siamak Daneshmand, MD Colin Dinney, MD Jason Efstathiou, MD, DPhil Igor Frank, MD Kris Gaston, MD...
  • An Introduction to the NIHR Evaluations,Trials and Studies

    An Introduction to the NIHR Evaluations,Trials and Studies

    Prof David Fone, Cardiff University . £420,000 (34months) Adapting . and piloting the ASSIST model of informal peer-led intervention delivery to the Talk to Frank drug prevention programme in UK secondary schools (ASSIST+Frank): an exploratory . trial.
  • Unified Modeling Language - WordPress.com

    Unified Modeling Language - WordPress.com

    UML (Cont.) UML menggunakan class dan operation dalam konsep dasarnya, maka ia lebih cocok untuk penulisan piranti lunak dalam bahasa-bahasa berorientasi objek seperti C++, Java, C# atau VB.NET. Walaupun demikian, UML tetap dapat digunakan untuk modeling aplikasi prosedural dalam VB...
  • Innovations Committee - Virginia Department of Education

    Innovations Committee - Virginia Department of Education

    Revised composite index for the 2020-2022 biennium (update input data from 2015 to 2017) Additional revisions to enrollment projections (Fall Membership and March 31 ADM) Revised Sales Tax and Lottery revenue projections. Revised VRS fringe benefit rates.
  • Get to know (Town Name) Population: Building Active

    Get to know (Town Name) Population: Building Active

    Building Active Communities. Directions: Insert two photos of active-living/active transportation community elements you are proud of in your town. Feel free to change the orientation of these photo boxes (visible in the "Normal" slide view setting) as needed.
  • Looking Glass Self - Learning with Skalberson

    Looking Glass Self - Learning with Skalberson

    Looking-glass self: a self-concept based on our idea of others' judgments of us. (1) We Imagine How We Appear to Others. I'm Very Cool (2) We Interpret Others' Reactions