THE STRESS OF MAKING treatment decisions and seeing multiple specialists—all while processing the impact of a life-threatening diagnosis—can be overwhelming for people who are diagnosed with cancer. But new standards rolled out by the American Society of Clinical Oncology (ASCO) and the Community Oncology Alliance aim to help oncology practices streamline their processes to provide patients with more seamless, evidence-based care.
“How often have we heard patients who are frustrated because their care is not coordinated?” says John Cox, a medical oncologist at Parkland Hospital in Dallas and an author of the guidance, which was published July 13, 2021, in JCO Oncology Practice. The recommendations focus on ways oncology practices can improve patient-focused care and commit to process improvement. Suggested measures include providing estimates for out-of-pocket expenses, educating patients about the goals of treatment, having discussions about palliative care and end of life, and implementing a survivorship care program.
These standards serve as the foundation of a certification program for oncology practices and health systems, building on a concept known as the oncology medical home. The concept puts the oncology practice in the role of coordinator much in the same way primary care providers help facilitate other health services for their patients.
Twelve practices and health systems across the country, including community, academic, and large and small practices, are participating in a pilot to fine-tune requirements for the certification program, called the Patient-Centered Care Certification. New England Cancer Specialists, a medium-sized oncology medical group with four locations in Maine and New Hampshire, joined the program in July 2021. “[The standards] have us asking ourselves: How do we engage our patients in education?” says Claire Cote, the chief operations officer at New England Cancer Specialists in Scarborough, Maine. “What evidence-based pathways are we following when we prescribe chemo or immunotherapy? And how are we making sure we are providing equitable care across various areas? How do we provide advance care planning?”
The model of care was first popularized in pediatrics in 1967.
The oncology medical home is based on the patient-centered medical home (PCMH) concept, which was introduced by the American Academy of Pediatrics in 1967. This model looked to centralize and coordinate the care of various pediatric specialists who were providing services to children with special health needs. Decades later, family medicine specialists adopted the PCMH model. The concept of putting the patient at the center of oncology care was popularized by the Community Oncology Alliance in 2012.
Practices that meet the oncology medical home certification program are expected to help ensure continuity of care by communicating with various specialties, including primary care physicians. “We need to reach out to these practices ahead of time to engage other specialties we interact with to ensure we are getting the right information back and forth and providing patients seamless trajectories across these silos of care,” says Cox. The pilot program also fosters collaboration across the enrolled practices, who share their approaches to meeting the standards.
Some studies suggest the oncology medical home model can reduce emergency department visits, inpatient admissions and the overall cost of cancer care. Thus, one goal of these efforts is to document outcomes and cost savings so health insurance companies are more likely to reimburse for patient-centered services, says Cox. Anthem, a U.S. health insurance provider, is participating in the pilot, and ASCO’s goal is to have additional payers sign on. “We have involved payers in the pilot to understand how they see the value of practices that jump through these hoops,” Cox says. “We will learn about the quality of care delivery through practices that are instituting this model and make adjustments after the pilot.”
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