One of the foremost objectives of a patient-centered medical home (PCMH) is to reduce unnecessary specialty visits through effective management of acute and chronic illnesses. Invariably, though, some conditions require more costly specialty care. Among these conditions, cancer is notable for the extent to which it becomes the primary medical focus immediately upon diagnosis and establishes the context in which all other conditions must be managed. In that sense, PCMHs face particular challenges in managing patients with cancer, because much of their care transitions to specialists and settings that do not share the PCMH’s incentives for coordination, integration, and cost containment.
But oncology providers, like primary care practices, are facing increasing pressure from payors and patients to deliver high-quality care in an efficient and economical manner. With the realization that rising drug prices and a growing elderly make it nearly impossible to meet these goals without fundamentally changing the way cancer care is delivered, oncology providers across the country have begun exploring ways to produce better outcomes while reducing costs.
One approach that has shown promise in meeting these objectives is the oncology medical home (OMH). Similar to a “medical home” in primary care, the OMH is not a singularly defined concept; a practice can be recognized as an OMH by several different organizations. However, the National Committee for Quality Assurance’s (NCQA’s) patient-centered specialty practice (PCSP) is currently the most established model among oncology practices seeking official recognition, and the NCQA has formed partnerships with several organizations to develop specific patient-centered oncology care standards.
PCSPs employ a holistic approach to care and coordinate with other providers to promote patient health, from the initial oncology referral through treatment and survivorship planning. Thus, a PCSP will look and feel quite different than its counterparts with a more traditional, stand-alone approach that only addresses a patient’s cancer and its direct physical effects. But the differences are also quantifiable: practices adopting PCSP and similar standards have been outperforming national benchmarks for clinical and financial outcomes, with improvements including:
- Fewer ER visits and hospital admissions among chemotherapy patients
- More patients receiving hospice care within the last few months of life
- Overall savings of nearly $1 million per physician per year
Despite the potential benefits, practices should not underestimate the changes that may be required to achieve similar results. Any program considering OMH/PCSP recognition would be wise to conduct a comprehensive assessment that compares its current-state performance with the specific recognition requirements. Gaps may be identified in any number of areas, including technology and infrastructure, operations and access, and organizational culture. The gap assessment can then be used to estimate the change timeline and extent of investment required for successful accreditation, and ultimately to decide whether to move forward.
For many practices, the most challenging element of PCSP adoption is the shift in perspective required for team-based patient management, particularly with primary care. In going beyond the specialty “silo,” adopting a truly patient-centered approach requires more than putting information-sharing systems and processes in place. Specialty providers must recognize primary care’s critical role, and primary providers must be willing to relinquish some elements of patient care to their specialists. But most importantly, both sides must believe that the health of each patient is a responsibility they share. When providers are driven to help each other because their incentives are better aligned, everyone benefits – but no one more so than the patients they serve.
John D. Sprandido, M.D., FACP, “Oncology Patient-Centered Medical Home,” Journal of Oncology Practice, May 2012.
Ted Okon, “Legislation Impacting Cancer Care,” Community Oncology Alliance, 2015 GASCO Spring Administrators’ Meeting, March 2015.
Joseph Burns, “COME HOME Program Set to Save $33.5M Over 3 Years,” OncLive, August 2014.