The Oncology Care Model: Why Care Coordination is Essential

Posted by Cam McClellan Teems

March 18, 2016 at 12:17 PM



As part of the government's desire to bring down the cost of cancer care, CMS announced the launch of the Oncology Care Model, which aims to help cancer doctors reduce hospital and pharmacy costs. Applications were accepted and in 2015 finalists were chosen for the first round of participation.  Starting in 2016, the OCM payment model is beginning to pay qualifying oncologists $160 per month for each beneficiary receiving chemotherapy. But oncology clinics and hospitals that receive this risk-based payment are required to make certain changes to the way they meet patient needs. The changes – which are HUGE – include:

  • Providing 24/7 patient access to an appropriate clinician with real-time access to patient records 
  • Using an ONC-certified EHR and attest to Stage 2 of meaningful use (MU)  
  • Using data for continuous quality improvement
  • Providing the core functions of patient navigation – see full list below
  • Documenting a care plan for every OCM patient in line with the 13 components in the Institute of Medicine Care Management Plan
  • Treatments consistent with nationally recognized clinical guidelines

The core functions of patient navigation include:

  • Coordinating appointments with providers to ensure timely delivery of diagnostic and treatment services
  • Maintaining communication with patients, survivors, families, and the health care providers to monitor patient satisfaction with the cancer care experience
  • Ensuring that appropriate medical records are available at scheduled appointments
  • Arranging language translation or interpretation services
  • Facilitating financial support and helping with paperwork
  • Arranging transportation and/or child/elder care
  • Facilitating linkages to follow-up services
  • Community outreach
  • Providing access to clinical trials, and
  • Building partnerships with local agencies and groups (e.g., referrals to other services and/or cancer survivor support groups) 
The bottom line is that oncology, which basically invented the discipline of patient navigation or care coordination, remains the most mature specialty in applying best practices. Certainly, it shows the way forward with other specialties, which will no doubt follow some of the oncology template as they come to terms with similar risk-based and value-driven payment models.

Topics: EHRs, oncology, Navigation & Care Coordination, Payment Models

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