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+ © Oncology Management Services, 2015. + Part I. Oncology Patient-Centered Medical Home Overview.

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Presentation on theme: "+ © Oncology Management Services, 2015. + Part I. Oncology Patient-Centered Medical Home Overview."— Presentation transcript:

1 + © Oncology Management Services, 2015

2 + Part I. Oncology Patient-Centered Medical Home Overview

3 + The Oncology Patient-Centered Medical Home is a model of healthcare delivery that empowers the physician-led care team and enables them to practice to the best of their abilities. The goal of OPCMH is to standardize the science of medicine, so that care teams can practice the art of medicine—and thereby provide better healthcare to our patients. The OPCMH model offers a significant value proposition to a wide-range of healthcare constituents and to society… What is OPCMH © ?

4 + OPCMH offers providers a model of care Empowering them to thrive economically in a value-based environment Delivering consistently high-value healthcare Enabled by high-value, low-cost technology OPCMH offers payers and health systems Innovative aligned payment methodology options IT to catalyze value-based transformation Implementation of model across a provider network Delivery of a value proposition based on controlling resource utilization and improving patient safety and desired outcomes Value Proposition

5 + Reorganizes roles and responsibilities of the existing team No need to recruit additional staff in most cases OPCMH may require fewer staff members per physician May not require extended hours OPCMH engages patients to report symptoms early and often— and it works Streamlines administrative & technical barriers in the care team work environment (authorization process, EMR functionality, documentation burdens, transcriptions costs, etc.) Highlights of the Model

6 + Patient and physician-centered High-value patient care cannot be consistently delivered if the model of delivery does not seek to optimize the physician and care team work- environment Minimize clinically irrelevant physician activity Top down value solutions (e.g. pathways programs, EMRs) often do not understand the physician and care-team work environment Highlights of the Model

7 + Barriers to quality = Physician Time Stealers:

8 + Barriers to Cost Control Drivers of cost = unnecessary resource utilization (waste) Waste is driven by failures in: Delivery CoordinationClinical Domain Over-utilization Pricing Administrative Burden Administrative Domain Fraud

9 + OPCMH focuses first and foremost on standardizing the care team work environment.

10 Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging ©2014 Oncology Management Services, Ltd. Payer Based Episode and “OMH” Programs CMS & Commercial

11 Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial

12 Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial

13 Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial

14

15 + Part II: The Prototype OPCMH Consultants in Medical Oncology & Hematology (CMOH)

16 + Increased Productivity & Decreased Overhead: 2013: 8.8 physicians, 3 service locations Support staff to fulltime physician ratio 5.6 (2007 baseline 8.3) Business Enhancement: Enhanced FFS, PMPM, shared savings, precertification relief Improved documentation, coding, coordination Improved physician efficiency, productivity, QOL New referral patterns Development of Alternate Payment Models: APM contracts (IBC, Keystone First) Covering 48% of practice patient base Performance benchmarked against the market

17 + Projected % Reduction in Cancer Care Cost 1-3 Chemotherapy pathways program Inpatient hospitalizations (5-25% reduction) ER evaluations (20-40%) Diagnostics End-of-life care coordination Total 6.6 – 12.7 % reduction Annual cancer “spend” $125B = $8-16B savings Adapted from international consultants evaluation of OPCMH TM application to cancer care

18 PCORI funded Oncology Project (SEPA) NCQA, OMS, ASCO, RAND, NCCS, IBC CMS Oncology Payment Reform TEP MITRE, Brookings, RAND, CMS, CMMI Oncology Bundled Payment Consortium CAP, CMS, CMMI, multiple payers ASCO Payment Reform Initiative OMS CMOH Alternate Payment Methods SEPA IBC, Keystone First, (48% of patients) Traction

19 Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

20 Not for redistribution. © 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology

21 Not for redistribution. © 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology USON/Milliman: Approximately 2 emergency room visits per chemotherapy patient per year (14 million commercially insured; 104,473 cancer patients) Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009 © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

22 USON/Milliman: Approximately 1 hospital admission per chemotherapy patient per year (n=14 million commercially insured; 104,473 cancer patients) Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009

23 Not for redistribution. © 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology Provider Ability & Accountability Payment Reform for cancer care FFS Pathways OPCMH Episode or Budgeted Payment model

24 Part III. Scaling the Model Oncology Management Services

25 + Solutions ToolsTechnologySupport IrisPractical Guide Practice Assessment & Gap Analysis Symptom Management Program (triage algorithms, patient instructions) Webinars Seminars Practice Consulting Payer & Policy Organization Consulting Oncology Management Services Network Management & Contracting

26 + Point-of-care, physician-centric software that minimizes the barriers physicians and care teams face in providing value-based healthcare. Iris is the tool that enables successful OPCMH transformation. Iris enhances the OPCMH model of care by guiding and facilitating workflow, minimizing clinically irrelevant activities, while collecting and reporting clinically actionable data in real-time at the point of care. Iris compliments EMR functionality. EMRs commonly provide a detailed roadmap of how to impede value-based healthcare delivery. Iris minimizes each of these barriers and enables seamless transformation. Iris™: The OPCMH Enabling Technology

27 + The Iris effect: Iris™

28 + Iris TM The Barriers to Cost Control Iris TM addresses these cost drivers: Delivery Coordination Over-utilization Pricing Administrative Burden Fraud

29 + Hospital Admission Team Home Care Team Hospice Team Survivorship Care Team Tumor Registry State Department of Health Plan Medical Directors Plan Auditors Referring Physicians Associated Treating Physicians Consulted Specialists Patients Nurse Manager Triage Nurse Billing staff Patient Navigators Emergency Department Iris TM Consumers

30 + Iris™ OMS APP EMR OMS APP External Apps (SMART-on-FHIR) An Enabling Ecosystem

31 + Thank you! Contact Information John D. Sprandio Visit us at to register for OMS’ Healthcare Delivery Seminar


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