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Preparing for Alternative Payment Models: Aligning Clinical Practice With Quality Metrics

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American Association of Community Cancer Centers


J Clin Pathways. 2021;7(2):44.

ACCCQuality reporting is a critical part of value-based care, providing the justification for optimal reimbursement and continued participation in alternative payment models. However, the gap between current clinical workflows—previously established for the needs of fee-for-service reimbursement models—and workflows tailored to the successful gathering of quality metrics can be significant.

At the Alternative Payment Models Coalition Workshop at the ACCC 47th Annual Meeting & Cancer Center Business Summit, Clearview Cancer Institute’s Anne Marie F Rainey, MSN, RN, CHC, showed attendees how to critically assess their program’s clinical workflows and align them with quality reporting.

Clearview Cancer Institute (CCI), a network of nine locations in Alabama that sees 700 to 800 patients a day, participates in the Oncology Care Model (OCM) and other pathways programs with private payers. Ms Rainey, Compliance and Quality Control Officer at the Huntsville location and OCM Project Manager, shared two concrete examples of its successful process for aligning clinical workflows with quality reporting: the documentation of advanced care directives and the completion of depression screenings.

CCI first looked at the quality metrics it was already measuring to see where there was overlap with OCM reporting requirements, accreditation standards, and other benchmarks. The program also examined the state of its workflows, staffing, and technology.

CCI then performed a SWOT analysis, named for the four areas of examination: strengths, weaknesses, opportunities, and threats. Clearview had a robust electronic health record (EHR) system that allowed for easy workflow modification, as well as intake staff who could push paperwork through the system (strengths). However, there was no established process for documenting advanced care directives—less than 1% of patients had anything in their chart about them—and patients eligible for depression screenings were falling through the cracks (weaknesses). Adjusting clinician workflows to capture new quality metrics would both improve patient care and ensure success in the OCM (opportunities), but new workflows would place an additional burden on clinicians and could potentially affect their success (threats).

With the SWOT analysis done, CCI began the process of adjusting its workflows. When a new component was added, such as asking if patients had a living will, data was captured and evaluated; feedback was collected; and adjustments were made to the workflow. This cyclical pattern of workflow adjustment and data preparation ensures continuous improvement: “One is always going to impact the other, and there is always going to be some kind of cause and effect,” said Ms Rainey. By adjusting the workflow slightly, indications that advanced directives were complete climbed to 95% across all patients.

For CCI, improvement was realized by making greater use of medical assistants (MAs). Before a clinician meets with a patient, an MA talks to them. Lists of patients eligible for the PHQ-9 depression screening tool were sent to MAs each day, screenings were documented in the EHR, and patients were referred to the appropriate supportive service. 

To generate stakeholder buy-in for these workflow changes—identified as a threat in the SWOT analysis—Ms Rainey said that staff were educated about the importance of this newly aligned documentation process. Ms Rainey stressed the importance of having this education upfront, as CCI wanted staff feedback before and after implementation. Staff were continually updated on the results of their efforts, as many clinical staff responded positively to seeing change in action. 

CCI tied compliance with new workflow processes to annual raises and bonus potential, a measure that made it clear quality reporting was an organizational priority; MAs received monthly dashboards tracking their efforts. Patient feedback was also important, as any positive feedback could be relayed to clinicians and nurses to further stress the value and importance of meeting new quality metrics.

Overall, Ms Rainey considered CCI’s participation in the OCM a success, due in part to the alignment of clinical workflows and data reporting. The program received participation rates because of its performance, its workflows were made more efficient, and care quality improved with the introduction of patient-centered questioning and screening.

To watch an on-demand replay of the Alternative Payment Models Coalition Workshop—as well as every session held at the ACCC 47th Annual Meeting & Cancer Center Business Summit—visit

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