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

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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

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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