Oncology patient-centered medical home and accountable cancer care

Transcription

1 Ocology patiet-cetered medical home ad accoutable cacer care Joh D. Spradio, MD Cosultats i Medical Ocology ad Hematology, PC, Drexel Hill, PA With the passage of healthcare reform ad the call for improved quality, value, ad demostratio of results, the primary care patiet-cetered medical home (PCMH) cocept has gaied cosiderable tractio across the Uited States. I 2004, we bega re-egieerig our processes of cacer care delivery i our medical ocology practice cocurretly with the implemetatio of a ocology-specific electroic medical record ad the developmet of customized software to better suit practice/patiet eeds ad to facilitate data collectio. These custom software applicatios were desiged to support comprehesive processes of care that were also required for level III medical home recogitio by the Natioal Committee for Quality Assurace (NCQA). We have bee trackig our data for the past 5 years, documetig improvemets i disease maagemet otably the reductio i emergecy room utilizatio ad hospital admissios. We have egaged local ad atioal payers with the goal of developig collaborative pilot programs. Furthermore, we are establishig formalized relatioships with other like-mided medical ocology ad primary care PCMH practices, as we cotiue to refie our delivery of cacer care withi a ocology PCMH model. M edical ocologists are playig a ever-expadig role i the de livery of cacer care. The curret ad future challeges they face i their efforts to deliver effective, efficiet, ad appropriate cacer care are broad, ad solutios to the risig costs of cacer care cotiue to be sought. The patiet-cetered medical home (PCMH) model has emerged as a partial solutio to the fragmeted delivery of primary healthcare. I may istaces, the delivery of cacer care is also fragmeted fraught with deficiecies i commuicatio, coordiatio, ad accoutability. The ocology PCMH (OPCMH) model of cacer care may potetially serve as a practice framework for ocologists. The OPCMH model attempts to promote a value-based ageda that facilitates physicia accoutability, ecourage cliical itegratio betwee like-mided medical ocology groups, ehace commuicatio ad coordiatio of care with primary care PCMH models, ad collaborate with payers while maitaiig a focus o patiet eeds ad evidece-based care. A backward glace at the PCMH model A combiatio of factors has led to the rapid acceptace of the PCMH model i the delivery of primary care: (1) physicia ad patiet recogitio of the PCMH model as a partial solutio to the uacceptable fragmetatio of healthcare delivery; (2) the availability of electroic medical records (EMRs) ad the actioable iformatio that ca be mied from cliical databases; (3) the aligmet of icetives amog stakeholders, icludig the largest employers i the Uited States, medical professioal societies, cosumers, isurace compaies, academic istitutios, patiet advocacy groups, state Medicaid agecies, ad the Ceters for Medicare & Medicaid Services; ad (4) early results from medical home demostratio projects, suggestig that elemets of the model may have a positive effect o quality, cost, ad satisfactio of the patiet ad cliical team. 1,2 Uacceptable fragmetatio of care I order to address the fragmetatio of care, there are a umber of actios that physicias should take: care for patiets across the cotiuum, improve the coordiatio of care, establish a stadardized comprehesive process of care, adhere to established practice guidelies, utilize a care-team approach, egage ad educate patiets to ehace ivolvemet i their care, ad create iovative ways of commuicatig with all parties ivolved. EMR systems Whe fully implemeted ad ehaced, EMR systems have the potetial to promote a culture of cotiuous improvemet that creates practice efficiecies. Furthermore, EMRs ca potetially allow physicias to cocetrate o their primary resposibilities of makig complex medical decisios based o real time, evidece-based data while establishig ad maitaiig persoal relatioships with their Mauscript received November 16, 2010; accepted December 3, Correspodece to: Joh D. Spradio, MD, Cosultats i Medical Ocology ad Hematology, PC, 2100 Keystoe Aveue, Suite 502, MOB, Drexel Hill, PA 19026; telephoe: ; fax: ; Elsevier Ic. All rights reserved. Commu Ocol 2010;7: Volume 7/Number 12 December 2010 COMMUNITY ONCOLOGY 565

2 patiets. Customized software ca allow for streamliig ad stadardizig care, trackig multiple disease maagemet data poits i patiets with co-morbid coditios, ad facilitatig the idetificatio ad measuremet of potetial complicatios of therapy ad disease. Aligmet of iterests The various stakeholders embracig the medical home model of care have specific iterests ad perspectives. Their idividual ad collective assessmet of curretly provided medical services is critical i moldig the future defiitio of value i healthcare. The value of the medical home model i primary care is clear: by egagig more proactively with chroic disease patiets to maage symptoms ad chart disease progressio over time, providers ca reduce acute evets, thus decreasig resource utilizatio while improvig outcomes. These same priciples ca be applied to the delivery of cacer care, where the fiacial ad cliical stakes are ofte higher. Applicatio of the PCMH model of care to ocology Patiets with cacer curretly receivig active treatmet represet less tha 1% of the commercially isured populatio, but they accout for approximately 10% 12% of healthcare expeditures. The cost of cacer care i the Uited States is risig at a usustaiable rate of 15% 20% aually. 3 I may istaces, the delivery of cacer care is fragmeted fraught with deficiecies i commuicatio, coordiatio, ad accoutability. I additio, patiets with cacer geerally ted to be a vulerable, older, chroically ill populatio with multiple co-morbid coditios ad uique psychosocial eeds. The fiacial plight of the primary care physicia is well kow ad log-stadig. It is widely recogized that reimbursemet for evaluatio TABLE 1 The expadig role of the medical ocologist Coordiate complex multimodality treatmet plas Adhere to established treatmet guidelies Coordiate care Assist patiet avigatio through care Case maagemet Educate patiets Promote patiet egagemet Improve documetatio capabilities Commuicate with referrig ad cosultig physicias Deliver ad coordiate palliative care ad maagemet services has simply ot kept pace with the complexity of tasks required of physicias i deliverig improved quality care. Virtually every payer atioally recogizes this discoect ad is makig adjustmets, icludig the cosideratio of paymet for the PCMH model i primary care. I may ways, the dilemma of the medical ocologist is the same as that of the primary care physicia. 4 I the commuity-based ocology area, these problems have bee exacerbated by the perverse methodology of payig physicia practices for the drugs they admiister after discouts from pharmaceutical compaies a model that has eroded over the past several years. Historically, up to 85% of cacer care delivery was provided i commuity-based medical ocology practices. 5 The previous reimbursemet model allowed medical ocology practices to assume a icreasig degree of resposibility for avigatig patiets through the complex, fragmeted maze that all too ofte is cacer care i this coutry. Medical ocologists have played a ever-expadig role i the delivery of cacer care (Table 1). More recetly, ocologists have bee asked to provide fiacial couselig to address the spiralig cost of drugs ad the risig co-paymets ad Have icreasig o-demad patiet access to care Proactively address complicatios of disease ad treatmet Track testig ad appoitmet compliace Create specific disease registries Develop ad dissemiate high-risk patiet databases Create ad execute survivorship care plaig Pla ed-of-life care deductibles dictated by the isurace idustry. The curret medical ocology E&M (evaluatio ad maagemet) paymet schedule has ot supported these expadig resposibilities, the curret call for improvemets i quality care, or the advacemet of the cocept of value i cacer care. The healthcare reform legislatio, ad may of the recetly iitiated programs i respose to it, promotes a critical focus o patiet eeds, value, quality, ad results. The applicatio of a PCMH model to cacer care fits very propitiously at this momet with healthcare reform. A ocology patietcetered medical home (OPCMH) i actio Cosultats i Medical Ocology ad Hematology, PC (CMOH), provides hematology ad ocology care withi three health systems i southeaster Pesylvaia. CMOH became the first ocology practice i the atio to ear level III recogitio from the Natioal Committee for Quality Assurace (NCQA) uder its Physicia Practice Coectios Patiet- Cetered Medical Home (PPC PCMH ) program i April The practice was recogized for usig iformatioal systems to measure practice-wide cliical quality parameters ad for improvig cliical outcomes at the poit of care. 566 COMMUNITY ONCOLOGY December

3 The PPC PCMH program idetifies practices that promote parterships betwee idividual patiets ad their persoal physicias, rather tha episodic office visits for patiet care. Each patiet is teded to by a physicia-led care team. The curret OPCMH model beig developed by CMOH is straightforward. At the time of the diagosis of cacer, the practice assumes the primary resposibility for the coordiatio of all related services for patiets requirig evaluatio ad active treatmet of their ocologic ad hematologic coditios. Resposibility of care delivery cotiues through all ecessary therapy icludig surgery, radiatio therapy, ad chemotherapy ad exteds ito the survivorship phase of care. The practice does ot assume the maagemet of oocologic medical issues from the patiet s primary care physicia, ecessitatig the maiteace of a itese level of commuicatio betwee the practice ad the primary care team. The OPCMH model of care essetially provides a framework for defiig ad refiig the cocepts of quality ad value i cacer care. CMOH bega to re-egieer its processes of care i By Jauary 2006, all four offices had trasitioed to paperless operatios. Practice IT capabilities were fully iterfaced with the laboratory, radiology, pathology, ad medical record departmets of all affiliated hospitals. The IT ifrastructure ad the processes of care evolved, allowig for the creatio of a uique spectrum of patiet services that ehaced the level of coordiatio of care ad the collectio ad evaluatio of cliical data. This cycle of data collectio ad evaluatio fuels cotiuous improvemet withi the practice. NCQA medical home recogitio requiremets. To achieve level III recogitio, the practice satisfied the followig ie stadards outlied by the NCQA 6 : Icreased patiet access ad ehaced commuicatio Patiet trackig ad registry fuctios, icludig remiders for prevetative screeigs Care maagemet ad adherece to atioally accepted, evidecebased stadards of treatmet Patiet self-maagemet ad support as a strategy for avoidace of potetial complicatios of treatmet ad disease Electroic prescribig ad physicia orderig Test trackig ad moitorig patiet compliace Referral trackig Cotiual performace reportig ad improvemet Advaced electroic commuicatios icludig a portal for patiets ad referrig physicias. Ocology-specific PCMH goals. To apply the PCMH model to cacer care, CMOH focused o the followig aspects of care delivery: Streamlie ad stadardize the process of patiet evaluatio i the medical ocology office Coordiate all aspects of cacerrelated evaluatios ad services beyod the medical ocology office via patiet avigators Proactively promote a iterdiscipliary approach to maagemet Costatly collaborate betwee the cliical support ad treatmet teams Stress the importace of patiet educatio, egagemet, ad compliace Ehace patiet access to allow proactive maagemet of symptoms via exteded hours, telephoe triage services, ad physicias o-call Miimize cliically irrelevat physicia activity Fix accoutability for care delivery at the physicia-patiet locus Assume owership of cacer-related eeds i a highly persoalized way. Customized software. The key to the executio ad delivery of OPCMH services is the re-egieered process of care ad the customized software ehacemets ecessary to support them. Software was developed to better suit physicia, patiet, ad practice eeds to format, stadardize, ad collect critical patiet maagemet ad utilizatio data. Cacer care is plagued by commuicatio ad coordiatio gaps, commoly exposig patiets to coflictig iformatio, duplicate procedures, cofusio about treatmet plas, uaswered questios, ad icomplete medical records. 7 It is geerally uderstood that the ability of curret EMR software to support data collectio ad coordiatio of care is suboptimal. EMRs have ot bee desiged to readily move iformatio betwee sites. As a result, patiet records are commoly iaccessible to referrig ad cosultig physicias. 8 Coordiatio of care is ot oly essetial for deliverig quality i cacer care, it is also a prerequisite for maitaiig ad expadig lies of referral. 9 Listed below are OPCMH software ad process ehacemets: IRIS ocology physicia documetatio tool: 1. Immediate completio of stadardized documetatio 2. Timely commuicatio with autofaxig or EMR iterfaces 3. Physicia documet maagemet review program 4. Referrig/cosultig physicia portal access 5. Recorded symptoms as a prompt i the IRIS documetatio software, esurig all active cliical issues are addressed 6. Stadardized ursig assessmet ad documetatio of patiet symptoms ad ECOG (Easter Cooperative Ocology Group) performace status, verified by the physicia 7. Curret ad logitudial data preseted to the physicia at the time of the visit 8. Assessmet ad pla autopop- Volume 7/Number 12 December 2010 COMMUNITY ONCOLOGY 567

4 ulated with active cliical issues 9. Ed-of-life-care discussios prompted based o chages i disease ad performace status Performace status ad NCI (Natioal Cacer Istitute)-graded review of system trackig Palliative care symptom maagemet Telephoe triage system ad data collectio Outside testig result ad appoitmet trackig ad compliace Customized patiet educatio, symptom maagemet istructios Ehaced patiet queuig ad trackig Uscheduled visit utilizatio trackig Remote access to most recet medicatio list ad laboratory results Health screeig ad immuizatios trackig. OPCMH patiet avigators. I additio to utilizig techologic resources ad educatioal programs, CMOH also traied patiet avigators to assist patiets. Their tasks iclude gatherig all cliical data, removig barriers to care by arragig all ecessary appoitmets with specialists ad primary care physicias, ad schedulig all ordered testig to improve the timeliess of care. The CMOH patiet avigators are also istrumetal i coectig patiets to support services ad commuity resources. Full EMR adoptio allowed CMOH to retrai admiistrative assistats to serve i these ehaced patiet directive roles withi stadardized guidelies beig oversee by the physicia. OPCMH patiet egagemet ad empowermet. For a OPCMH practice to perform optimally, patiets must be fully egaged i their care. Emphasis is placed o patiet behavior ad a clear uderstadig of patiet ad practice resposibilities. OPCMH patiet orietatio emphasizes the followig items: The NCQA recogitio of patiet- ad family-cetered care Guidelies for patiets to become parters i their ow care: 1. Prepare questios prior to their appoitmets 2. Ask questios util they uderstad their situatio ad optios 3. Accept their resposibility to report ay ad all symptoms early 4. Uderstad the cocept of early itervetio, i relatio to emergecy room (ER) ad hospital admissio avoidace 5. Utilize telephoe triage system ad ehaced access to care Become familiar with how to access ad use the features of the patiet portal. Positive results thus far CMOH has see positive results sice Particular areas of improvemet i care follow: OPCMH phoe triage system. The campaig to make patiets more ivolved i their ow care has resulted i a dramatic icrease i timely cliical phoe calls to CMOH s triage system. Traied urses utilize customized symptom maagemet algorithms to address cliical issues, resultig i every cliical call beig tracked, recorded, ad aalyzed. Over 75% of all cliical calls resulted i the maagemet of symptoms at home. Approximately 10% of cliical calls resulted i a uscheduled office visit withi 24 hours. Less tha 5% of cliical calls resulted i ER evaluatios. OPCMH triage ER referrals. The umber of icomig cliical calls resultig i ER referral decreased by more tha 50% over a 5-year period. The actual umber of ER referrals via our telephoe triage service remaied relatively stable over that same time, despite a 30% icrease i patiet volume (Figure 1). OPCMH uscheduled visits. As a result of expadig patiet access to the CMOH cliical staff, the umber of uscheduled office visits withi 24 hours of a cliical call more tha doubled durig a 5-year period (Figure 2). OPCMH chemotherapy patiet ER utilizatio. ER referrals for patiets actively o treatmet progressively decreased sice 2004 (Figure 3). The curret practice average is less tha oe ER visit per patiet per year (Commercial, Medicare, ad Medicaid populatios icluded). This umber compares favorably with ER utilizatio rates of two per patiet per year, reported i a large commercially isured populatio. 3 OPCMH admissio data. As CMOH developed ad expaded OPCMH-related programs across the practice, it documeted a 16% reductio i overall hospital admissios i fiscal year 2009, with a additioal 9.7% reductio i fiscal year 2010 (Figure 4). OPCMH symptom maagemet stadardizatio. CMOH has targeted a series of potetially avoidable complicatios ad stadardized the cliical assessmet of complicatio-related symptoms to directly reduce patiet morbidity ad resource utilizatio. Stadardized dehydratio prevetio educatio ad maagemet resulted i a dramatic decrease i the icidece of dehydratio addressed by ER evaluatio ad hospital admissios. Logitudial moitorig of the success of palliative care measures is facilitated, measured, ad documeted by software ehacemets. Stadardized maagemet of outpatiet diarrhea resulted i a decrease i admissios for the treatmet of Clostridium difficile eteritis by 50%. A stadardized approach to isomia may have resulted i reduced levels of fatigue ad idirectly may have improved performace status. Isomia-related symptoms are also utilized as a screeig tool for depressio. Validatio of these results is curretly i progress. Stadardized prevetio of delayed chemotherapy-iduced ausea ad vomitig has decreased the icidece 568 COMMUNITY ONCOLOGY December

5 Percetage of patiets directed to ER via phoe triage FIGURE 1 Percetage of patiets directed to a emergecy room (ER) as a result of a cliical call versus the total umber of active patiets. Number of uscheduled visits % 8.58% ,359 4, ,908 4, of delayed post-treatmet ausea. It also resulted i a sigificat practicewide reductio i the iappropriate use of oral 5-hydroxytrypt amie 3 (5- HT 3 ) ihibitors for delayed chemotherapy-iduced ausea (Figure 5). 5, % Year 5,321 Percetage of patiets directed to ER Number of active patiets see 5,153 Patiets see withi 24 hours of cliic call Patiet populatio 197 Year 6.13% 5,321 5, % ,000 5,000 4,000 3,000 2,000 1,000 FIGURE 2 Number of patiets see withi 24 hours of a cliical call versus the total umber of active patiets , ,000 5,000 4,000 3,000 2,000 1,000 Total umber of active patiets Total umber of active patiets OPCMH performace status trackig. Performace status serves as the focal poit of patiet-cetered care. It is the basis for decisio-makig o the day of plaed chemotherapy admiistratio ad is used logitudially as a guide to the iitiatio of ed-of-life-care discussios ad timely hospice referrals. From 2005 to 2009, o the day of chemotherapy admiistratio, roughly 90% of treated patiets had a ECOG performace status of 0 or 1, ad 8.7% had a ECOG performace status of 2. OPCMH ed-of-life care. CMOH recetly iitiated a iteral auditig program to measure physicia performace regardig the documetatio of ed-of-life-care discussios with patiets i a ocurative settig (stage IV disease). CMOH measures the documetatio of ed-of-lifecare discussios i the physicia assessmet at the time of the iitial outpatiet cosultatio. Reassessmet ad cofirmatio of ed-of-life-care discussios are triggered whe a patiet presets with a ECOG performace status of 3. The progressio of this discussio durig successive office visits also is moitored. Edpoits measured i the last 8 weeks of life iclude ER, itesive care, ad hospital admissios (icludig legth of stay); chemotherapy admiistratio; radiatio therapy; ad hospice erollmet ad duratio. OPCMH palliative care. I patiets udergoig active treatmet for metastatic o-small cell lug cacer, the priciples of palliative care have bee show to improve quality of life ad media survival while promotig more appropriate ed-of-life care. 10 The OPCMH model icorporates palliative care i cojuctio with stadard ocology care. CMOH physicias ca logitudially track symptoms ad performace status i real time, at the poit of care. Furthermore, all cliically active issues ad symptoms are followed i a ruig assessmet ad pla documet for referece, with cosideratio at the time of cliical decisio-makig. Adherece to cliical guidelies. Cliical guidelies, based o recommedatios from the Natioal Comprehesive Cacer Network ad the Volume 7/Number 12 December 2010 COMMUNITY ONCOLOGY 569

6 ER evaluatios per patiet per year Year FIGURE 3 Average emergecy room (ER) evaluatios at Delaware Couty Memorial Hospital of the Drexel Hill office populatio per chemotherapy patiet per year, (YTD). Number of admissios ,239 3, America Society of Cliical Ocology, are built ito treatmet care plas withi the ocology EMR. Adherece to these guidelies is a essetial compoet i the OPC- MH model ad is tracked at the Fiscal year ,173 3,192 3,222 3, , FIGURE 4 Number of admissios to Delaware Couty Memorial Hospital (DCMH) versus the patiet populatio i the Drexel Hill office durig fiscal years Number of admissios, July fiscal year DCMH patiet populatio 307 3,500 3,000 2,500 2,000 1,500 physicia ad practice levels. Number of patiets Curret ad future challeges Assessig ad improvig value i cacer care. Scott D. Ramsey, MD, PhD, the Committee Chair of the Plaig Committee o Assessig ad Improvig Value i Cacer Care Workshop, was recetly quoted: Ulike may areas i health care, the practice of ocology presets uique challeges that make assessig ad improvig value especially complex. A practical workig descriptio of value i ocology would beefit may stakeholders ad serve as a useful model for other fields of medicie. 11 As previously metioed, the curret ad future challeges ocologists face i their efforts to deliver effective, efficiet, ad appropriate care are broad ad move well beyod a focus limited to pharmaceutical costs ad drug utilizatio. 11 The OPCMH model of cacer care ca potetially serve as a practical framework to more effectively address these challeges. The model has the potetial to promote a value-based ageda that facilitates physicia accoutability, ecourages cliical itegratio betwee like-mided medical ocology groups, ehaces the commuicatio ad coordiatio of care with primary care PCMH practices, ad productively collaborates with payers while maitaiig a focus o patiet eeds ad evidece-based care. Ehacig physicia accoutability. At CMOH, accoutability for the coordiatio of cacer care has bee placed o the shoulders of the medical ocologist. Stadardizatio of the appropriate extesio of physicia oversight is a potetial aswer to the impedig ocology physicia shortage; a shift of cliical resposibility to urse practitioers or physicia assistats out of ecessity due to sheer volume is ot. To promote physicia accoutability without creatig additioal burdes, the practice eeded to create physicia efficiecies. This process was largely accomplished by facilitatig ad streamliig the approach to tedious data collectio, time-cosumig documetatio, ad timely commu- 570 COMMUNITY ONCOLOGY December

7 Number of 5-HT 3 prescriptios ad refills Year FIGURE 5 Number of prescriptios ad refills for oral 5-hydroxytryptamie 3 (5-HT 3 ) ihibitors durig the first 6 moths of 2005, 2007, 2009, ad icatio. Coddled by a well-utilized EMR, re-egieered process of care, ad custom software programs, the OPCMH structure is capable of miimizig cliically irrelevat physicia activity, thereby maximizig physicia efficiecy ad accoutability. Stadardizig ad itegratig cliical care. CMOH strives for cotiued improvemet, aticipatig cofirmatio of the value of a patiet-cetric approach i the delivery of ocology care by expadig the OPCMH template ad ifrastructure to others. Through horizotal itegratio with like-mided medical ocology practices both academic ad commuity-based the practice hopes to facilitate the stadardizatio of iitial assessmet ad treatmet algorithms. By regimetig data-collectio poits withi the shared or separate EMRs, CMOH plas to track utilizatio i a larger populatio. Robust commuicatio ad itegratio also allow for the sharig of strategies i disease maagemet. Extesio of the OPCMH template to a similar-sized practice is uder way Refills Prescriptios 6 20 I additio, CMOH is egaged i discussio with two large primary care groups for potetial cliical itegratio opportuities. The goal is the developmet of EMR iterfaces to allow data-sharig ad better maagemet i the followig areas: (1) iitial hematology ad ocology evaluatios; (2) potetially avoidable complicatios i patiets with multiple comorbid coditios; (3) establishmet of the poit of first triage durig cacer therapy; (4) embeddig of case maagemet ito the process of care; (5) avoidace of duplicative laboratory ad radiographic studies; (6) facilitatio of ed-oflife-care discussios; (7) trasitios i care from a ipatiet settig; (8) stadardizatio of the referral of high-risk patiets at the level of the primary care practice; ad (9) stadardizatio of survivorship care plas with a agreed-upo resposibility matrix. The America College of Physicias Coucil of Subspecialty Societies recetly established the defiitio of a PCMH eighbor (PCMH-N), the framework for iteractios, ad the guidig priciples for the developmet of care-coordiatio agreemets betwee the primary care PCMH ad the specialist PCMH-N. 12 Ecouragig payer collaboratio. As the cost of cacer care is risig at a usustaiable rate, payers ad govermet programs are lookig for solutios, especially i light of projected icreased demads. Other curret ocology maagemet solutios available to payers are trasitioal at best. They ted to focus overwhelmigly o chemotherapy costs, which accout for approximately 26% of the total amout spet o cacer care. 13 This arrowly focused approach oly partially advaces the quality-of-care ageda ad does ot advace the value propositio from the patiet service ad disease maagemet perspective. It has bee established that adherece to chemotherapy treatmet pathways does result i the stadardizatio of drug utilizatio ad cost reductio. 14 A OPCMH practice is costructed with a fully deployed treatmet pathways program, providig more predictable chemotherapy costs. The medical home model of cacer care, as discussed, looks beyod chemotherapy drug pathway compliace. Practices with OPCMH capabilities will be positioed to become future providers of choice, capable of trasitioig to value-based paymet models. 15 The OPCMH is potetially trasformatioal. Noe of the other efforts that payers are cosiderig provides a sustaiable busiess model for commuity ocologists. The OPCMH ifrastructure does. Focused o the essetial demad for improved quality ad value, irrespective of the paymet model or the orgaizatioal structure of the parties adoptig it, OPCMH is flexible eough to accommodate whatever paymet chages may come i the future. CMOH has ecouraged payers to collaborate to further refie ad verify this model. Volume 7/Number 12 December 2010 COMMUNITY ONCOLOGY 571

8 Refereces 1. Evidece of quality. Patiet-Cetered Primary Care Collaborative. pcpcc.et/cotet/evidece-quality. Accessed December 5, Paulus RA, Davis K, Steele GD. Cotiuous iovatio i health care: implicatios of the Geisiger experiece. Health Aff (Millwood) 2008;27: Cacer patiets receivig chemotherapy: opportuities for better maagemet. Millima Cliet Report. millima.com/research/health-rr/pdfs/cacerpatiets-receivig-chemotherapy.pdf, released March 30, Accessed December 5, Alice G. Gosfield, JD, of Philadelphia s Alice G. Gosfield ad Associates, PC [persoal commuicatios]. March NCI Commuity Cacer Ceters Program Pilot: Natioal Cacer Istitute Web site. FactSheet.htm. Accessed December 5, PPC-PCMH Cotet ad Scorig summary. =vdhh2t5alse%3d&tabid=631&mid=2435& forcedowload=true. Accessed December 5, USA Today, Kaiser Family Foudatio, ad Harvard School of Public Health. Natioal survey of households affected by cacer. November upload/7591.pdf. Accessed December 5, O Malley AS, Grossma JM, Cohe GR, Kemper NM, Pham HH. Are electroic medicie records helpful for care coordiatio? experieces i physicia practices. J Ge Iter Med 2010;25: Update o Cosumers Views of Patiet Safety ad Quality Iformatio, October The Hery J. Kaiser Family Foudatio pdf. Accessed December 5, Temel JS, Greer JA, Muzikasky A, et al. Early palliative care for patiets with metastatic o-small-cell lug cacer. N Egl J Med 2010;363: Schickedaz A. Assessig ad Improvig Value i Cacer Care: Workshop Summary. Rapporteur, Istitute of Medicie. Accessed December 5, Kirscher N, PhD. Seior Associate, Isurer ad Regulatory Affairs, America College of Physicias [persoal commuicatios]. September Klei I. Aeta, Medical Director [persoal commuicatios]. November Neubauer MA, Hoverma JR, Kolod- ziej M, et al. Cost effectiveess of evidecebased treatmet guidelies for the treatmet of o-small-cell lug cacer i the commuity settig. J Ocol Pract 2010;6: Cacer at the Crossroads: Achievig Market Differetiatio While Positioig for Success i the Era of Accoutable Care. The Advisory Board Compay. Washigto, D.C. Ocology Roud Table Natioal Meetig Series ABOUT THE AUTHOR Affiliatio: Dr. Spradio is the lead physicia of Cosultats i Medical Ocology ad Hematology, PC, a idepedet private practice located i Drexel Hill, Ridley Park, Newtow Square, ad Brito Lake, PA. Coflicts of iterest: Developmet of the ocology patiet-cetered medical home (OPCMH) model was self-fuded by the practice, Cosultats i Medical Ocology ad Hematology, PC (CMOH). There were o exteral corporatios or istitutios affiliated with the developmet of the OPCMH model. The author has a owership iterest i both the practice, CMOH, ad Ocology Maagemet Services Ltd, the developers of the custom software ehacemets specifically desiged to support the OPCMH model of cacer care. Dr. Spradio curretly does ot serve o ay corporate advisory boards. 572 COMMUNITY ONCOLOGY December