Barbara L. McAneny, MD
More than 2 years after the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the progression toward valuebased care has challenged oncologists to assume an unprecedented degree of accountability for the well-being and holistic care of their patients. Those practices participating in the Oncology Care Model (OCM), with its extensive practice transformation requirements, got a head start. Now the Meritbased Incentive Payment System (MIPS) compels many more to evaluate their clinical, financial, and administrative readiness for these new reimbursement models. What will determine success? The ability of practices to increase control over the drivers that affect quality and costs of care—across all patient conditions and settings of care.
Participating practices mobilized enhanced services including patient education and medication management counseling; team care; 24/7 practice access (telephone triage, night/weekend clinic hours, and on-call oncologists); on-site or near-site imaging and laboratory testing; and admitting physicians who shepherd patients through inpatient encounters, avoiding handoffs and inpatient admissions, to ensure seamless, safe, and efficient care. In the 3-year course of the program, compelling results included:
- A decrease of 7.2% in the overall cost of care
- Declines in inpatient hospital admissions (12.5%), 30-day hospital readmissions (11.7%), and ED visits (6.6%)
- Improvements in quality of life and quality of care for patients Although the potential of COME HOME was not always easy for the participating practices, the lessons learned provide a road map for success with value-based reimbursement models, including:
- Focus on high-risk patients as they reach critical decision points. For our practices, patients amid specific treatments are those at greatest risk for adverse events such as nausea and pain that, if not addressed in a timely and compassionate manner, can quickly escalate.
- Prioritize avoidance of the highest-cost events. COME HOME focused on the drivers of greatest avoidable cost and major sources of distress for patients: unnecessary inpatient admissions, ED visits, and readmissions.
- Recognize that practice transformation is necessary to optimize results. COME HOME practices were led by committed leadership willing to enact cultural change in support of more holistic patient support and then back that up with staffing and workflow models to enhance triage capabilities across all care settings.
With the conclusion of the COME HOME program, IOBS has focused on broadening access of COME HOME resources for the entire oncology community now embracing value-based care through MIPS and the OCM. One important milestone was our collaboration with ASCO to replicate and expand our tools across the United States. This partnership was launched in November 2016.
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