Dr Kerin Adelson on Changes in Care Coordination Precipitated by OCM

Through the Oncology Care Model's impact on preventing unnecessary utilization, particularly for in-patient care, resources derived from its use has enhanced care coordination and led to the formation of novel infrastructure and clinical pathways, said Kerin Adelson, MD, associate professor, chief quality officer, and deputy chief medical officer for Smillow Cancer Hospital at Yale New Haven/Yale Cancer Center.

Transcript

AJMC®: How has the Oncology Care Model (OCM) changed the approach to care coordination?

Dr Adelson: In my practice, the OCM was really designed with attention to preventing unnecessary utilization and especially in-patient care. So, there's some caveats to that. So, when you look at older models, financial models of cancer care delivery, in-patient care was a major driver of cost. What we have seen in the last decade where the cost of pharmaceuticals are increasing and increasing, the amount of that total pie that actually goes to in-patient care or preventable utilization has gotten smaller. And the OCM was really focused on optimizing utilization, enhancing care coordination, communication with patients, and improving patient-centered care, with the idea that all of those things–better goals of care, better end-of-life planning, better advanced directives–would lead to decreased utilization.

I think that is happening in a number of practices. We're seeing nationally rates of hospitalization are improving. But I think sort of what the program didn't fully expect was how much this issue of drug costs was going to become a driver of overall cost. The model, while it has said you need to use guidelines, these very expensive drugs are included in the guidelines, and with no ability to negotiate price, which CMS doesn't have, there's really little opportunity to curb the overall costs of drug therapy.

So, I think where the OCM has been most transformational, at least here at Yale, is that it's this understanding that we take care of the patients, not just when they show up in clinic or land in the hospital, but there are patients throughout their whole disease trajectory, including when they're at home, and that it's our job to be touching base with them, providing them with the services they need, and giving them that enhanced care coordination that will ultimately keep them out of the hospital and make sure that the care we're giving is in line with their wishes.

So, the OCM has enabled us to build some very substantial infrastructure. We have an urgent care center, so our patients don't have to go to the ED [emergency department] where they get disease specialized symptom management. We've hired these very senior nurse care managers who follow patients, again, across the trajectory both when they're in the hospital or in clinic, and keep an eye on them and make sure that those patients who are at highest risk for hospitalization or other bad outcomes are getting the care they need.

We also did use revenue from the OCM to implement clinical pathways so that we can be sure that across our network of 15 sites and the big academic main campus, that patients are being offered clinical trials, and that they're getting the most sort of evidence-based, effective, least toxic treatments that we can give. And none of that would have been possible without the resources that come through the OCM.