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Horizon, RCCA Launch Pilot to Close Care Gaps Between Cancer Treatments

Mary Caffrey
New Jersey's largest payer will track a host of measures, including some that will evaluate the quality of end-of-life care.
Regional Cancer Care Associates (RCCA), which treats more than 24,000 new patients a year across 3 states, will work with New Jersey’s largest payer, Horizon Blue Cross and Blue Shield (BCBSNJ), to close care gaps by using oncology nurse navigators to monitor patients between treatments.

According to information from Horizon, a 3-year agreement calls for nurses to reach out to patients between appointments, using an integrated system to follow each patient’s progress. The patients will have a phone number to contact a nurse navigator if they need transportation or other services.

“Instead of reacting to adverse conditions that can arise between cancer treatments, such as dangerously low hemoglobin counts that trigger [emergency room] visits and hospital admissions, we’re taking a pro-active, coordinated approach to care,” Allen J. Karp, senior vice president of Healthcare Management for Horizon BCBSNJ, said in a statement.

The pilot is expected to reach about 2000 Horizon patients who receive care at one of RCCA’s 24 New Jersey locations. It will track a host of measures, including time to treatment, medications used, unplanned readmissions within 30 days, number of emergency department visits, and number of inpatient admissions.

Horizon will track quality of care outcomes based on guidelines from the American Society of Clinical Oncology. Of note, the agreement calls for tracking chemotherapy given within the last 2 weeks of life, an important standard for end-of-life care everywhere, but one with potential to make a big difference in New Jersey. There is widespread agreement that the state spends too much and keeps patients in the hospital against their wishes, prompting the state legislature to spend $5 million last year to create a better education and training model to promote palliative care.

While high spending has been a concern among public officials, Horizon spokesman Kevin McArdle said the pilot is not designed to track cost-per-patient against usual care. “The purpose is to get members to the care they need at the right place at the right time,” he said in an e-mail to The American Journal of Managed Care®.

“We are excited to participate in this groundbreaking pilot here in New Jersey,” Terrill Jordan, president and CEO of RCCA, said in the statement. “By working more collaboratively with Horizon, we are empowering our physicians and their clinical staff to follow the progress of our patients beyond the 4 walls of our local clinics.”

McArdle said the agreement has 2 parts: patients receiving treatment in the adjuvant setting will be enrolled for 9 months, which could be extended; patients with metastatic or recurrent cancer will be followed on an ongoing basis. "We'll be feeding data into the COTA to track treatments and outcomes, and we'll learn best practices from that," he said, referencing the Cancer Outcomes Tracking and Analysis system founded by RCCA physician and former president, oncologist Andrew Pecora, MD, who is the chief innovation officer at Hackensack University Medical Center.

Under the care model, Horizon will pay a monthly medical management fee for nurse navigators to manage the patient. McArdle said Horizon examined the Medicare Oncology Care Model, which pays the care coordination fee to the physician practice, but this model specifically ties the fee to the use of the navigators. 

 
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