Northeast Ohio hospitals see benefits from CMS oncology model

Hospitals in Northeast Ohio are seeing improvements through a federal program they're participating in that's aimed at providing higher-quality, more highly coordinated care to Medicare cancer patients.

Under the Oncology Care Model — a payment and delivery model from the Center for Medicare & Medicaid Innovation — physician practices work under payment arrangements that include financial and performance accountability for chemotherapy treatment and the care surrounding those patients. It's one of the many programs that the CMS are promoting to help shift payment models from a fee-for-service arrangement to a value-based approach.

"I think the OCM program is really a commitment to continuous learning and cycles of improvement," said Matthew Kemmann, director of strategic planning and analytics for University Hospitals Seidman Cancer Center. "It's really sort of re-engineering everything we do in a very thoughtful way in trying to continuously improve and again move toward this model of care which is increasingly more personalized for patients."

There are 178 practices across the country participating in the model, according to CMS. In Northeast Ohio, UH, Cleveland Clinic and Summa Health all joined the model in July 2016. Lake Health also is participating in partnership with UH, and SummaCare — Summa Health's insurance arm — is one of 13 payers also participating.

About halfway through the five-year program, systems in the region are seeing cost savings, reduced emergency department visits and more.

While the program focuses on Medicare beneficiaries, the health systems have extended enhanced services — such as care coordination, navigation, financial counselors and national treatment guidelines for care — to all of their patients.

"Everything that we have done for the OCM project or that had to be recorded for the OCM project, we extended to all of our patients," said Kimberly Bell, administrator for cancer services at Cleveland Clinic. "We don't treat anybody any differently, so everybody has access now to multiple social workers, multiple care coordinators, pharmacists."

Expanding access

Practices participating in the model are given a per-member per-month stipend to help them create programs and offer resources to get to that higher-quality, more highly coordinated, cost effective care. The CMS sets some guidelines, but it doesn't specify exactly how to achieve that, Kemmann said.

At UH, the system used that per-member per-month money to add about two dozen full-time equivalents in the areas of patient access, financial counseling and mostly, nurses and care coordinators. Kemmann said the single biggest intervention the system has implemented is an oncology RN specialized call center that operates based on evidence-based protocols for how to manage urgent clinical concerns for cancer patients.

"UH is known for compassionate care, personalized care, but it's really hard to get to that for every single patient on a consistent basis sometimes, so what these resources have done is sort of provide that bridge," he said. "What the OCM has done is allow us to invest in these resources to deploy a model that is a step further toward patient-centered care while we wait for reimbursement policy to catch up."

Similarly, Cleveland Clinic added between 20 and 30 full-time equivalent positions. Nurse coordinators, social workers, pharmacists and finance navigators now are employed at the clinic's regional sites. Previously, many of those services were central to main campus.

Summa, too, focused on making sure that patients had access to behavioral health services, palliative care, social work and good triage plans to keep patients out of the hospital, said Dr. Sameer Mahesh, program director for Summa's Oncology Care Model.

Summa has also implemented stringent protocols around how often patients are imaged and tested; initiated efficient triage for patients calling into the office; and began using infusion centers as urgent care centers, taking care of immediate needs instead of having the patient wind up in an emergency room.

Results

Summa has seen its cost of care go down, Mahesh said, noting that its beneficiary per month was lower than the national average. The system also has seen ED visits go down and is reporting a 4% mortality rate, lower than the national 5% average, he said.

UH has seen a significant reduction in ED utilization and a modest reduction in inpatient admissions, Kemmann said, noting that other measures, such as end-of-life metrics, have been favorable as well.

Cleveland Clinic has also seen its ED visits drop, as well as its readmission rates.

The ultimate goal of the program is to decrease the cost of care by 4%. Organizations that do achieve that cost savings will receive a payout from CMS, Bell said. At the clinic, that amounts to savings of about $4 million and, so far, the system has saved $3.5 million, she said.

"What I don't want people to think is that anyone is trying to not provide good care by these efficiencies — that's not it at all," Bell said. "We're actually providing better care, because our patients, if they go into a hospital, if they go to an ED, they're more at risk than if we could keep them out of the hospital. It is a win-win. You have to keep your quality up and your expenses down."

"Northeast Ohio hospitals see benefits from CMS oncology model" originally appeared in Crain's Cleveland Business.