Innovation in Oncology Payment Reform: Reports from Real-Life Practice
Four innovators from oncology practices across the country described how payment reform is shaping the way they treat cancer. While each of their experiences is unique, they all seemed to arrive at the same conclusion: one must find ways to adapt to the changing healthcare landscape.
To begin, Leonard Kalman, MD, discussed how Advanced Medical Specialties (AMS), a Florida-based health system, provides cancer care. With the patients at the center of their focus, AMS’s goal is to achieve the triple aim: access, quality, and cost. They also utilize several “levers” to control their costs of care. Those include appropriate management of chemotherapy and supportive care drugs, the early introduction of supportive/palliative care in metastatic patients, and appropriate management of other high cost procedures. He noted that the levers are also important in controlling the large amounts of “spend” that go toward administering chemotherapy, as well as hospital inpatient costs, surgery/anesthesia, and radiation therapy.
“If you’re going to reduce costs, you have to have a culture change among physicians, and a culture change among patients and their surrogates,” Dr Kalman says. “If you don’t change the culture, the expectations at the end of life are going to be too high, and you’re not going to reduce readmissions.”
Stuart Genschaw, MHA, MBA, executive director at Michigan-based Cancer & Hematology Centers, followed Dr Kalman. There, care is coordinated amongst a team of physicians and support staff. Like Dr Kalman’s practice, Cancer & Hematology Centers personalizes the treatment of each patient, recognizing that improving outcomes requires patient buy-in and trust. He also discussed the oncology medical home they started 2 years ago. He described it as a negotiated agreement made directly between a practice and a payer.
“The focus of the oncology medical home was preferred regimens; we wanted to focus on advanced care planning and survivorship,” he said. “The support of our medical home was around cost savings, and this was decreasing ER visits and hospitalizations.”
Barry Russo, CEO of Center for Cancer and Blood Disorders, has similar goals at this practice in Texas. Their organization focuses on a patient’s entire episode of care when treating cancer. They recently entered into a contract with Aetna, and will become part of its oncology medical home shared savings program. Major components of this agreement include pathway compliance, advanced care planning, survivorship, and other quality-focused initiatives. They also were one of the original participants in the UnitedHealthcare’s “episode fee program,” which had positive phase 1 results. Mr Russo said the saw “significant cost savings” for the Center. He added that they hope to move into phase 2, and to integrate a shared savings component.
Finally, Barbara McAneny, MD, CEO, New Mexico Oncology Hematology Consultants (NMOHC), Ltd, said her organization benefited from a $19.8 million grant from the Centers for Medicare & Medicaid Services. The grant was for a clinical trial of operations, with the goal of determining whether the policies and procedures implemented at NMOCH had produced cost savings by keeping people healthy. It also aimed to determine whether it was scalable, and if it could be implemented at other practices across the country. The study provided positive evidence for the benefits of focusing on patient-centered care.
“The idea really is to manage those things that we can effectively manage, which are the side effects of cancer and its treatment. We can’t control the cost of drugs—there’s a lot of things we can’t control—so we focus on the things we can,” Dr McAneny said.