Patient Centered Medical Home: Driving Value in

Cancer Care

Presented by:Cami Leech Florio, FACHE, PCMH CCE

Vice President, OperationsOncology Resource Networks

The Continuum of Cancer Care

Challenges in Cancer Care

• Highly complex • Fragmented• Expensive

“The complexity of the cancer care system is driven by the biology of cancer itself, the multiple specialists involved in the delivery of cancer care, as well as a health care system that is fragmented and often ill prepared to meet the individual needs, preferences, and values of

patients who are anxious, symptomatic, and uncertain…”

SOURCE: INSTITUTE OF MEDICINE, DELIVERING HIGH QUALITY CANCER CARE, 2013

Costs of Cancer Care The National Cancer Institute estimates that costs of cancer care in 2010 were $124.6 billion….in 2020, the costs of cancer care will rise to more than $158 billion.

Milliman notes that oncology patients under active treatment represent only 1% of a payer’s patients…the care of these patients accounts for approximately 10% of costs

AHRQ’s Medical Expenditure Panel Survey, 2011 indicates that the top 3 most expensive medical conditions are: Heart conditions, cancer and trauma.

How do we achieve the Triple Aim in Cancer Care?

SOURCE: IHI HTTP://WWW.IHI.ORG/ENGAGE/INITIATIVES/TRIPLEAIM/PAGES/DEFAULT.ASPX

Evidence-Based Medicin

e

Patient-Centered Care

Aligned Financi

al Incentiv

es

MonitorMeasure

Repeat Improve

PCMH Definition

“A health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient's family.”1

1 PATIENT CENTERED PRIMARY CARE COLLABORATIVE WWW.PCPCC.NET

Patient

Coordinated

Comprehensive

Safe and High

Quality

Accessible

How do we deliver Patient Centered Care?

Address the unique needs of the patient

Activate Care

Teams

Leverage Technolo

gy

Oncology PCMH Pilot Programs

Medical Oncology Home Pilot

(2011)

Oncology Patient-Centered Medical HomeTM

(2010)

Michigan Oncology Medical Home Demonstration

Project(2012)

Florida Blue Oncology ACOs:Moffitt Cancer Center

Baptist Health/Advanced Medical Specialties

Early Results of Pilot Programs Oncology Patient-Centered Medical Home in Pennsylvania:

o 68% reduction in ER visits per chemotherapy patiento 51% reduction in hospitalizations per chemotherapy patiento Estimated savings of $1 million per doctor per year

Wilshire Oncology Medical Oncology Home Pilot:o Fewer ER visits and hospitalizations (10% v 30%)o Fewer end of life hospitalizationso High compliance with nationally validated measures

Michigan Oncology Medical Home Demonstration Project:o Fewer ER visits and hospitalizations compared to control groupo Estimated savings of $550 per patient in first year

Metrics to Evaluate Success Common:

o ER visits and Hospitalizationso Length of stayo Evidence based guideline complianceo End of life planning and care

Evolving:o Patient performance statuso Patient satisfactiono Advanced imaging utilization

Quality

Value =

Cost

Final Thoughts The current focus on primary care is important and has great potential to impact future costs of cancer care by improving prevention and early detection.

However, we also need to consider how to positively impact the quality of life, outcomes and costs of today’s cancer patients and survivors.

Patient-centered care is the right thing to do for the patient, and we believe that the right care for the patient is also inherently higher quality and more cost effective.Alone we can do so little, together we can

do so much – Helen Keller