Whether you are a participant in a value-based pilot like Oncology Care Model (OCM) or possibly a watchful bystander now is the time to integrate best practices for patient navigation to better serve your oncology patients and enhance care efficiency.
A little background on the Oncology Care Model
At its core, the Center for Medicare and Medicaid Innovation’s (CMMI) Oncology Care Model (OCM) looks similar to a patient-centered oncology medical home with a target expenditure and shared savings component that encompasses the total cost of patient care during a particular period of treatment. The model is a voluntary, 5-year program slated to begin in spring 2016. Physician group practices, hospital-based practices (except for prospective payment system–exempt hospitals), and solo practitioners who furnish cancer chemotherapy were eligible to participate. While we don’t yet know which centers have been notified of participation, we do know that 427 groups submitted Letters Of Intent and just over 100 applications were accepted.
In addition to a fee-for-service payment, providers participating in the OCM will receive a care coordination payment to improve quality of care ($160 per patient, per month during the episode) and, to incentivize lower costs, a performance-based payment that will be based on the difference between a risk-adjusted target price and actual expenditures during the episode.
“ The oncology market has now forever been changed by events related to the OCM RFA. This includes care coordination, patient navigation and patient care management.” – Dawn Holcombe
Practices will need to meet certain quality metrics and undergo practice transformation requirements, including effective use of electronic health records, providing 24-hour access to practitioners who can consult the patient’s medical record in real time, developing comprehensive patient care plans, offering patient navigation services, and targeting continuous quality improvement. (Be sure to read more about OCM in this Carevive blog post: The Oncology Care Model Explained)
In a recent article, CMS Oncology Care Model: How Big Was the Leap of Faith?, Dawn Holcombe, MBA, FACMPE, ACHE summarized her experience working with several of the groups who submitted a letter of intent to CMS.
Ms. Holcombe outlined several important lessons learned in the article, with implications for all of us involved in oncology care. Of particular interest to many centers might be in the area of Patient Navigation.
“Although many practices believe they already performed good patient navigation,” Ms. Holcombe wrote, “When faced with the itemized list from the NCI, it became clear that this was going to be a more focused effort that would require dedicated staff and functions.”
The charge from the Oncology Care Model – ‘Provide core functions of Patient Navigation’
Participants were not required to hire additional staff to perform these ’core functions’, but were tasked to explain in their OCM application how they will ensure that the core patient navigation requirements will be met.
(For a complete list of quality and performance measures, see page 25-28 of the OCM Request for Applications)
As listed in the OCM RFA, The patient navigation ‘core functions’ were taken from the National Cancer Institute and they include:
- Coordinating appointments with providers to ensure timely delivery of diagnostic and treatment services
- Maintaining communication with patients, survivors, families, and the health care providers to monitor patient satisfaction with the cancer care experience
- Ensuring that appropriate medical records are available at scheduled appointments
- Arranging language translation or interpretation services
- Facilitating financial support and helping with paperwork
- Arranging transportation and/or child/elder care
- Facilitating linkages to follow-up services
- Community outreach
- Providing access to clinical trials
- Building partnerships with local agencies and groups (e.g., referrals to other services and/or cancer survivor support groups).
Now…The 4 Ways to Gear Up for the OCM
1. Begin with the end in mind. With future opportunities for care coordination payments and potential shared savings on the table, it’s essential that centers engage a multi-disciplinary team to create a business plan for improving patient outcomes. Take a look at the OCM quality measures and develop a business plan. Define the quality metrics at your institution that need improvement and then outline strategies to improve them. Include clinical and patient tools that support the process so your team has a way to analyze improvement in those metrics in real time. This process can prepare cancer centers for future financial success where performance/value based reimbursement models are inevitable.
2. Review your community needs assessment to better understand the healthcare needs of the community & to identify gaps. Are there additional ways to collaborate with clinical or community partners to provide patient navigation services across the continuum to meet program goals? (If you need additional resources, be sure to check out The Community Toolbox, a stellar one-stop shop for community collaboration.)
3. Map the patient experience across the continuum to identify quality improvements. Mapping part of the patient journey will enable you to look for opportunities for improvement by identifying points of inefficiency. The process also prompts good ideas and helps a team to know where to start to make improvements that will have the biggest impact for patients and staff.
Don’t have the time / resources to run a big mapping event? Prefer to start small to build up your knowledge and experience? Try the Alternative Mapping Guide, which is a nifty and realistic shortcut to get you started.
4. Identify efficient options for improved data capture & tracking value metrics. I have to be honest. It pains me when I hear that highly trained oncology professionals…nurses, social workers, nurse practitioners, are spending their precious and valuable time building Excel spreadsheets or using paper forms, or building templates. Electronic tools for patients to report data (like validated distress and symptom screening e-questionnaires) and associated data analytic software that mines EMR data will be critical to harness data around the quality measures you are trying to improve. Technology must also be leverage to keep oncology clinicians and their patients abreast of the evergrowing science of cancer care and its impact on evidence-based patient care. Once these technologies exist, we have to figure out how to integrate such tools into clinic in a way where they can help improve workflow. It will take a village, but the Carevive team and our expert faculty from around the country are here to help.
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