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Redefining Value in Modern Cancer TherapiesDebra Patt, MD MPH MBAExecutive Vice President, Texas OncologyClinical Professor, Dell Medical SchoolMedical Director Analytics, McKesson Specialty HealthAustin, Texas
DisclosuresEmployee: McKesson Specialty Health, Texas Oncology
Cancer 2020
4
18 million cancer survivors
1.7 million persons diagnosed with cancer
$157 billion in cost
A. Marriotta et al. JNCI 2011
AARP estimates a $150,000 cost for a cancer diagnosis
Moving from Volume to Value
Requirements to Receive a Performance-based Payment (Shared Savings)
§ Actual costs are lower than 96% of the benchmark amount§Report on quality measures to the OCM Registry§ Implement all practice redesign activities
6
BenchmarkCost
Actual Costs Perform.
Multiplier
Performance-basedPayment
Avg Episode-$27,634
OCM E2-6: The US Oncology Network
7
aThere are also multiple other products, such as My Care Plus or Lynx Mobile, that can be used to tract patients,
.
ü Investing in care teams & enhanced services for patients
ü >105% of enrollment & MEOS plan
ü >20 commercial value-based care agreements
- 15 network practices- 900+ physicians- ~68K+ patients enrolled
in 1st 2.5 yrs.- McKesson Specialty =
~30% of OCM
§ iKnowMeda
§ Decision support§ Clear Value Plus§ Practice Insights
Integrated Technology Value-based Care Best
Practices:
• Actionable analytics
• Navigation & team care
• Urgent care slots & patient expectations
• Integrated patient-facing Tx plans
• My Choices, My Wishes
• Core eligibility & enrollment principles
• Medical oncologists• Radiation oncologists• Hematologists• Oncology surgeons• GYN oncologists• Urologists• Colorectal, neuro, thoracic, ENT,
pathology, radiologists
Physicians • Physician team collaboration• Patient consultation• Treatment decision• Treatment plan• Care path compliance• 24/7 patient management• High/low risk designation
Medical Assistant
• Patient write-ups• Patient check-in• ED/hospital follow-up• Documentation completeness
APP• Follow-up with patients• 1-on-1 patient education• “Urgent care” provider• ACP planning• Survivorship
Navigation• Appointment coordinator• Care team facilitation• Documentation completeness• Monitor hospitalized patients • Hospital discharge follow-up• Link to outside service providers• Coordinate with clinical research
to identify patients
PBR
• Preauths• Patient financial plan• Patient assistance follow-up• Patient balance follow-up
New Patient Intake & Schedulers• Insurance verification• Prior medical records• Schedule appointment• New patient packet• ID OCM candidates
Triage• Proactive patient site-of-service management• Symptom management• “Call log” follow-up
Social Worker
• Patient-needs monitoring• Psychosocial distress screening• Nutrition referrals• My Choices, My Wishes• Coordinate home support services
Nurse• Safety check• Patient education• Tx readiness assessment• Chair side order/patient check• Treatment delivery• High/low risk assessment• Patient surveillance protocols• Documentation completeness
Pharmacist
•Medication review•Clinical verification•Education
Care Team Approach Needed to Manage All the Pieces
9
Oncology Care ModelCare Delivery Model Before OCM
Consult
Survivorship visit (depending on clinician order/diagnosis
Financial counseling(if out-of-pocket)
Chemotherapy education
Chemotherapy treatment start
Chemotherapy treatment ends
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Oncology Care ModelCare Delivery Model After OCM
Consult Survivorship visit
Financial counseling
Chemotherapy education
Chemotherapy treatment start
Chemotherapy treatment endsValue pathway &
treatment planNotification of care team
Risk status
Drug initiatives:• Less Neulasta• Dose rounding• Dose banding• PRISM TIC
24/7 access to careSymptom
management
Depression & psychosocial
screening
Nutrition screening
My Choices, My Wishes
(ACP) by cycle 3
Palliative care referral –as needed at any point
during treatment
= Activities may be repeated more than once during treatment
Navigation & Social Work from Consult to Survivorship or EOL
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