From angst to analytics: lessons learned from an oncology care model internal pilot

The Journal of Community and Supportive Oncology. 2017 December;15(6): | 10.12788/jcso.0371

February 7, 2018|The Journal of Community and Supportive Oncology

Thirteen practices affiliated with the US Oncology Network (USON) were invited to participate in the Oncology Care Model (OCM), a value-based care initiative that required changes in the following domains: 24/7 coverage, electronic health records (EHR) certification, navigation and care coordination, continuous quality improvement, incorporation of the Institute of Medicine Care Plan, and adherence to nationally recognized guidelines. Although 24/7 physician coverage, access to EHR, and adherence to guidelines were routine for these practices, the other requirements represented significant challenges. To be prepared for this transformative opportunity, USON implemented a pilot program 4 sites 6 months before participation began to identify the practice changes that would be needed to meet OCM requirements with the goal of standardizing best practices that would be shared with other USON sites. Through the pilot, the practices developed team-based approaches for navigation, the treatment plan, team-based care, and a core technology platform to address extensive OCM documentation requirements. An ongoing challenge is addressing the cultural resistance to change, which can hopefully be addressed with data and outcomes. Unexpected findings included the difficulty in identifying eligible candidates, a need to increase emphasis on adherence to national guidelines, and a need for strategies to reduce hospitalizations and emergency department visits. The pilot program showed that several seemingly challenging aspects of the OCM were feasible and areas for improvement were identified for improving the patient experience while decreasing the cost of cancer care.

Accepted for publication September 14, 2017
Correspondence Marcus A Neubauer, MD; Marcus.Neubauer@Mckesson
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(6):e297-e302

©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0371

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We are now well underway into this transformation. The challenges with navigation, the treatment plan, and team-based care demonstrate how extensive the changes have been and continue to be. The documentation requirements are formidable, and some potentially unrewarding. Yet we have enrolled more than 15,000 patients collectively. We have standard operating procedures for most OCM processes. We will have an electronic treatment plan and electronic reporting tools for navigation, plan completion, and quality metrics. Most weeks we have small wins and aha moments with treatment plans, navigation, and team huddles. We have programs for advance care planning and survivorship. We have access to historical cost of care data for more than 60,000 patients with extensive hospice and end-of-life care cost metrics. We can see opportunities behind our efforts during this past year. This may be, as Churchill said, “the end of the beginning.”¹⁹

Acknowledgment
The authors thank Supriya Srinivasan, PhD, for editorial support.

References

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