Finding inefficiencies in operational processes to identify gaps, improve symptom management and adherence, and optimizing value-based care—these are a few of the advantages of implementing technology in the daily operations of a community-based practice.
This was the takeaway message from a series of presentations at the Association of Community Cancer Centers' 44th Annual Meeting & Cancer Center Business Summit, March 14-16, 2018, in Washington DC. Moderated by John Doulis, MD, Health Investment Partners Fund, presenters included Glenn Balasky, Rocky Mountain Cancer Centers; Barry Russo, MBA, The Center for Cancer and Blood Disorders (CCBD); and Charles Saunders, MD, Integra Connect.
Russo’s presentation started with CCBD's experience with value-based care transition, which he said started with several pilot program participations, including the bundled payment model
with UnitedHealth care and an episode-based reimbursement pilot. Additionally, CCBD was also one of the pilot clinics to participate in the COME HOME program
, created by Barbara McAneny, MD, and Aetna’s Oncology Medical Home
Russo highlighted the value in keeping patients engaged through technology. “In 2015 we piloted a patient-reported outcomes mobile technology, called Navigating Cancer,” he said. The company
developed a tracking software for smartphones that allows the care team to remotely monitor patient symptoms and side effects. The software sends patients a text message that opens up a mobile app where they can report side effects, confirm medication adherence, and request a call back.
Transformation to value-based care is ongoing, Russo said. Process changes adopted by their practices included implementing clinical pathways, centralizing patient intake, and implementing a nurse navigation program. He warned that “a 1-size-fits-all approach will not work in this care transformation process,” and that practices should personalize adoption based on the dynamics of each group.
“We established an internal case management program, along with an array of essential support services, that included psychotherapy, genetic counseling, social services, and palliative care. Our technology modifications were made to support and scale patient care.”
Data, Russo said, has gained new importance today. “It is essential to understand claims data, process it, and abstract value-based information from it, which can be tough to evaluate when the sample size is small.” He recommended using actuarial support to assess some of the claims data. “This process is integral to determine areas of focus to improve value-based care,” Russo said.
Balasky narrated the challenge of coordinating practice changes across clinics that are spread over a 150-mile area in Colorado. “Each site has their own methods and practices, and delivering change at these multiple sites can be difficult,” he said. He brought up some of the issues around complicated phone systems, inefficiencies with workflows, and lack of actionable insights as some of the problems they face with their practices. “In addition to awareness of value and embracing technology, it requires buy-in from all involved, which can be tough across multiple sites,” Balasky said.
Lessons learned, he added, are that, while technology is essential, people and processes are just as important.
Saunders brought in the perspective of a technology vendor, who also has experiences from previous positions as a clinician and a payer (he worked at Aetna).
Speaking about the nuances of participating in the Oncology Care Model, Saunders said that the per patient per month payment of $160 asks for a lot in return: advance healthcare information, enhance 24-7 patient access, provide evidence-based treatment guidelines, etc. It therefore becomes essential for practices to think beyond drugs to achieve savings, because drugs can only provide a 20% to 40% opportunity for savings.
“How can you reduce your service costs?” is the question, Saunders said.
Team-based coordination and management of care using patient engagement tools (such as text messaging and patient portals) is important. “Portals are not used as much, though, and patients should be provided different options because use is driven by their age or comorbidities,” Saunders said.
Additionally, practices need to be thinking about revenue and risk management, population management, and medication management.
How can you solve the data gap problem for MIPS/APM reporting?
“Gaps can evolve at various stages of the workflow, during analysis, and then CMS might also drop some data. So manual chart abstraction may, unfortunately, be needed at some point,” Saunders said.
According to Saunders, data integration should closely track the following sources of data: claims, electronic health record, laboratory data, drugs, hospital, sociodemographic, patient-entered, and genomic data. “This information has to be ingested, scrubbed to clean up the noise, and then analyzed after normalization” to be able to draw actionable information for implementation in the clinic.