Adding to the discussions on value-based care and insurance design at the Oncology Clinical Pathways Congress, Sibel Blau, MD, President/CEO, Quality Cancer Care Alliance Network Medical Director, Northwest Medical Specialties (NWMS), and Clinical Associate Professor, University of Washington, Tacoma, and Ray Page, DO, PhD, FACOI, FASCO, President & Director of Research The Center for Cancer and Blood Disorders, Fort Worth, Texas, presented from the provider perspective.
In their session, Drs Blau and Page described their practice networks and experiences in altering their practices away from a fee-for-service care delivery model to prepare for the value-based care ecosystem we will soon all be in. They highlighted the utility of symptom management pathways to avoid hospitalizations and emergency room (ER) visits and how oncology clinical pathways can support value-based delivery of chemotherapy and supportive care. The advantage of leveraging big data tools within a practice strategy—for the benefit of providers as well as payers—was also a topic of focus.
Dr Blau gave some background on the size and activities of NWMS, noting they have 5 locations around Tacoma; 13 physicians; 13 advanced practice providers (APPs); and over 250 other employees. They are one of the successful practices within the Oncology Care Model (OCM) and have 5 commercial value-based care contracts (which encompasses 80% of their patients). They are also QOPI and NCQA certified and use the Navigating Cancer symptom management/triage pathways.
The Center for Cancer and Blood Disorders has 21 physicians (ie, med-onc, rad-onc, gyn-onc, palliative care, breast surgery), 13 APPs, 9 sites of serves (5 full-time sites), and was one of the first users of Elsevier’s ClinicalPath (formerly Via Oncology Pathways). Like NWMS, Dr Page said his network is QOPI and NCQA certified, uses the Navigating Cancer symptom management/triage pathways, and participates in OCM.
They summarized the many difficulties facing the oncology field today, such as the well-known and dismal state of cancer care costs, which are estimated to surpass $240 billion by the year 2023. They also listed the limited oncology workforce and rising care costs being shifted to patients. Dr Blau said that they are practicing oncology care in a paradox: they have an increasing number of tools for precision medicine and new, better drugs available to patients yet the costs they are facing are exploding.
Drs Blau and Page have approached these issues using a variety of methods. As noted above, they both utilize the Navigating Cancer symptom management/triage pathways. These pathways are basically an electronic manual that guides triage staff to more deeply assess and respond to patient needs. Staff simply choose the applicable pathway(s) and review a list of pre-generated questions with the patient. Embedded branching logic prompts new questions based on the patient response, narrowing the margin of diagnostic error. There are 20 symptom management pathways with more in development. This helped both of their practices avoid a cumulative total of 426 ER visits, resulting in almost $4 million dollars saved.
They also explained the benefits of using pathways as a means to accomplish more value-based care. Oncologists have little to no control over drug prices, Dr Page said, and therefore accountability should be limited to utilization. Use of pathways can achieve a fair, adequate, and stable payment environment for oncology care. In addition, pathways can ensure the full range of services needed by patients with cancer is supported within a value-based reimbursement system that increases patient satisfaction and costs savings. Pathways also improve clinical trial access and accrual. Providers test pathways as a mechanism for measuring cost and quality in the resource use component of MIPS and as a key component of a new oncology-specific alternative payment model.
Drs Page and Blau concluded with an emphasis on big data and artificial intelligence in health care. If you are unable to command and apply big data technologies in your practice, Dr Page said, practices will face penalties and then risk dying. He said practices ought to explore risk stratification using big data, identifying the highest at-risk patients for death, admissions, depression, increased pain, etc, and putting rapid, appropriate interventions in place. Big data can also reveal whether you are performing well against quality standards and if your interventions are actually working.—Amanda Del Signore