John Sprandio, MD
For the past 10 years, John Sprandio, MD, has been standardizing care delivery processes for cancer patients.
This effort has transformed his practice in Drexel Hill, Pennsylvania, into a patient-centered medical home. In 2010, his Oncology Patient-Centered Medical Home (OPCMH) became the first cancer practice that the National Committee for Quality Assurance certified as a PCMH. In the same year, the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI) also certified the practice.
“About a decade ago, it became clear that we needed to standardize our care to minimize variation. We had to improve patients’ level of engagement in their care and reduce the barriers that physicians face when trying to deliver more consistent care in terms of quality and costs,” said Sprandio. “That’s why we streamlined processes and removed clinically irrelevant activities from the physicians so they could concentrate on delivering patient care. We developed a physician-led care team model of practice and then held members of the team responsible for the care they delivered,” Sprandio explained.
In 2010, Aetna and Innovent Oncology, a program supported by The US Oncology Network, started developing a similar model of care for cancer patients in Texas. Just as Sprandio does, these programs use evidence-based guidelines to reduce variation in care delivery. Nurses supplement the work of oncologists, thus helping to improve cancer care quality and reduce the side effects that patients experience.
The oncology medical home has attracted the interest of the federal Centers for Medicare and Medicaid Innovation (CMMI), which awarded $19.8 million in 2012 to Innovative Oncology Business Solutions, Inc, in Albuquerque, New Mexico, to implement and test community oncology medical homes in 7 practices in 6 states.
At the time, CMMI estimated that the 3-year savings from the project, called the COME HOME program, would reach $33.5 million. The program will serve patients with breast, colon, lung, pancreatic, and thyroid cancers, and those with lymphoma and melanoma.CMMI wants oncologists to address some of the failings in the way care is delivered to cancer patients, such as the fragmented nature of care, suboptimal outcomes, high costs, and patient dissatisfaction. “Through comprehensive outpatient oncology care—including extended clinic hours, patient education, team care, medication management, and 24/7 practice access and inpatient care coordination—the medical home model will improve the timeliness and appropriateness of care, reduce unnecessary testing, and reduce avoidable emergency room visits and hospitalizations,” CMMI said when awarding the funds.
Sprandio’s OPCMH aims to meet these same attributes. Under contracts with Independence Blue Cross and Aetna, the OPCMH serves Medicare Advantage and commercial members. Sprandio also has a contract with Keystone First to serve Medicaid patients. These 3 contracts cover 54% of the practice’s patients.
“Many complications that cancer patients experience related to disease or therapy are potentially avoidable. If you can avoid those problems, you decrease unnecessary resource utilization without restricting care,” he explained. This is the heart of patient-centered care.
“We’re not restricting or rationing care but instead we engage patients and encourage our physicians to target potentially avoidable complications, provide better service and track internal performance on a significant scale,” he explained.
“The physicians accept accountability for the success of their efforts because their goal is to become value-based providers and not volume-based providers.”
To improve patient outcomes, OPCMH physicians follow 22 internal performance metrics. Streamlining processes allowed the practice to increase patient volume by 30% and reduced the number of full-time equivalent staff per physician, Sprandio said.
To avoid unnecessary emergency department (ED) visits and inpatient stays, the practice introduced algorithms for a telephone triage system to get patients the care they need when they need it.
“For years we’ve been interested in reducing ED utilization because it’s inconvenient for patients and a source of bad decisions, such as unnecessary imaging, laboratory testing and other interventions,” Sprandio explained. “Nervous ED physicians were admitting patients in the middle of the night without calling us. We wanted to change that.”
“So we went on a patient engagement rampage and indoctrinated our patients with the idea that we are the point of triage for any symptom they have at any time, excluding emergent cardiovascular, orthopedic, or central nervous system events,” Sprandio said. “Now patients use our telephone triage service to get same-day visits or for us to provide management at home.”