Road Map to Success in the OCM: From Team Building to Implementation

In the previous article, “Road map to Success in the Oncology Care Model: Tapping into Human Potential via Sustained Engagement,”¹ we discussed teambuilding exercises that allowed members of our practice, Carolina Blood and Cancer Care Associates, to evaluate and tap into our biggest strength: the unused potential of our employees, given their experience. We also talked about how we recognized the problems with our previous model that stemmed from siloed, fragmented care and found ways to address them with our collective wisdom, ultimately leading to a roadmap toward patient-centered cancer care (PCCC). We combined subjective human experiences with an objective checklist that allowed us to remain in compliance with our road map. These exercises allowed us to dive deep into the human psyche and design truly patient-centric solutions. We learned that a true patient-centered approach would be a combination of objective, numerical, centripetal measures defined in the Oncology Care Model (OCM) and subjective centrifugal emotions, aspirations, and expectations. We created smart teams, enabling an efficient transition from volume to value. These exercises were similar to building a higher pyramid on top of what we already achieved during our journey toward Patient-Centered Speciality Practice (PCSP) accreditation by the the National Committee for Quality Assurance (NCQA)² in 2015. Although the transition to being a PCSP was speciality agnostic and truly patient centric, the OCM gave us a blueprint that was specific to the needs of PCCC.

Our team saw what was on the horizon in the early part of this decade, as the buzzword “value-based care” became common. We started planning to change proactively rather than reactively. Our leadership started engaging with payers to develop an active partnership to make the transition to value. We reached out to HHS as well as our largest commercial payer, BlueCross BlueShield of South Carolina (BCBSSC) to learn their vision and goals for better care. After a series of meetings, we narrowed down our transformation process to meet PCSP accreditation by NCQA (Figure 1). All these activities happened in parallel to us applying for OCM status.³

PCCC Transition Leading to PCSP Recognition

The process was divided into 6 core areas (Figure 1), with an overall aim to improve coordinated care and to fulfill the requirements of the PCSP accreditation, which led to our recognition as the first oncology clinic in South Carolina to achieve this status. We felt that PCSP accreditation helped us to improve the quality of patient care, reduce unnecessary costs driven by avoidable factors, and put the practice on the path to becoming a patient-centric experience. As a part of this last goal, our cancer clinic and infusion services already had a foundation corresponding with many of the OCM’s practice requirements. These changes aligned with our philosophy of including population health management

strategies to optimize clinical effectiveness and efficiency. Patient engagement helped us achieve shared decision making and for patients and care givers to become more proactive. In order to standardize treatment offerings, we adopted Choosing Wisely recommendations from specialty societies. These initial steps taken from 2014 to 2015 helped us prime our practice to be ready for the OCM. Upon being selected for the OCM, we still had to modify our practice to fulfill standards to remain in compliance with standards; therefore, we started additional learning systems. However, the OCM had required prescriptive standards we also had to meet to remain in compliance. Therefore, we made

additional preparations and took steps to shift from a specialty-agnostic PCSP to OCM through a transition into PCCC.

Steps to Transition to OCM Learning From Sustained Engagement

As we mentioned in the previous article, we brought our employees on board with the OCM transformation. In addition to the sustained engagement (SE) workshop that we discussed in the February issue of Evidence-Based Oncology™,¹ we carried out a series of meetings, initially on a weekly basis before shifting to monthly, to come up with ideas for a smooth transition to meet OCM requirements. Although the focus of these activities was on developing team spirit, we were also looking for group input into adhering to prescriptive steps, including 13-point care plans from the Institute of Medicine⁵ (IOM), now the National Academy of Medicine, navigation, etc. Being a small independent practice with resource constraints, we sought to crosstrain our employees within the scope of their existing work and licenses (Figure 2). We added nursing and pharmacy staff and encouraged all employees to undergo certification in oncology navigation. We also designated a lead employee to be the financial navigator, with the sole function of providing and coordinating resource lists for all patients who were either uninsured or underinsured.

PCCC Transition Focusing on Clinical Care

At the conclusion of the SE workshop, we concluded that additional steps would be necessary to enhance care through OCM requirements. At the end of the retreat, our team came up with several suggestions to highlight 2 areas of additional practice transformation.

The first one focused on addressing areas specific to improving clinical care (Figure 3) and the second focused on nonclinical pathways to address financial and other hardships experienced by patients and caregivers. Recognizing that financial toxicities are some of the most common but frequently ignored factors adversely affecting prognosis, we created lists of priorities and ways to address them.

A majority of the OCM participants had difficulties in implementing the 13-point IOM care plan,⁵ which involved multiple dimensions of communication, care coordination, etc. During our SE retreats, our employees came up with idea of designing a comprehensive patient education booklet, which addressed common elements such as employee job descriptions, adverse effects of chemotherapy, etc. Ultimately, we compiled a booklet covering most aspects of an IOM care plan. We kept additional folders to individualize material for each patient.

We also made significant financial and technological investments in starting in-house diagnostics, including flow cytometry and high-resolution computerized tomography scanning to address common emergencies for our patients. We added pharmacy staff to start in-office dispensing under the MD license to have better control over dispensing expensive oral chemotherapeutic agents. We added full-time nutrition and smoking-cessation counselors for lifestyle modification for secondary prevention. We also started clinical trials. Additionally, we decided to adopt evidence blocks from the National Comprehensive Cancer Network to use comparatively efficacious but cost-effective therapies.⁶

We had already started providing expanded access, including same-day, walk-in, and weekend access, as well as on an as-needed basis as a part of NCQA accreditation. After reviewing the feedback report from the CMMI at the beginning of the pilot program, we saw opportunities to reduce emergency department visits and hospital admissions as low-hanging fruit. However, we did not have resources to provide after-hours coverage to treat non-life-threatening emergencies. We collaborated with a local urgent care center to provide care, including labs, diagnostic radiological services, and infusion services. We essentially were able to provide all noncritical care in an outpatient setting.

One of our physicians was already certified in hospice and palliative care, and he also underwent certificate training as a voluntary chaplain. What we started as specialty-agnostic patient-centered care with a PCSP came full circle as a clinical care continuum specifically covering oncology care.

The second aspect of oncology-specific transformation we underwent included identifying nonclinical challenges patients face. These challenges include daily transport, financial hardships, and limited coverage.

Our team first listed all such challenges¹ and created a resource list. We learned that our local utility companies had a program that waived utility bills for patients with limited life expectancy. We made a list of volunteers willing to transport patients for treatment. We also partnered with a local nonprofit agency aging (Catawba Agency on Aging) to facilitate resource lists and assist patients to qualify for dual-eligibility status (Medicare and Medicaid) and for federal low-income subsidy programs through Medicare Part D, which would

provide oral drug coverage to dual-eligible citizens.⁷ We included all this information in our patient education booklets.

What started as baby steps to transition our practice from volume to value via PCSP accreditation resulted in a very efficient and truly PCCC delivery site recognized by NCQA and CMMI. We additionally started an OCM pilot with BCBSSC.

The practice transformation process took time and resources. It often seemed unachievable, but after completing the transformation to a PCSP, we have been able to negotiate reimbursement for additional nonevaluation and management cognitive services as well as for weekend services.

Pursuit of the practice transformation had already started reflecting with better care for our patients and yielded many benefits to all the stakeholders for our group. Patients experienced the benefits of fully patient-centric care, greater care coordination and communication, a more well-established relationship with their physicians, and real-time/on-demand access to care. Our physicians experienced the benefits of standardization of the science of medicine, practice revenue stabilization, improved efficiency, and standardized

data compilation.

Payers benefited from a reduction in “cancer spend” and increased patient engagement in the care process, care that is assured to be appropriate to the patient’s condition, and focus on reducing avoidable complications.

We currently operate 2 infusion suites. Both facilities are single-story buildings allowing patients easy access around the entire facility. Aesthetic appeal was a large priority when creating the buildings to ensure a warm and welcoming environment for the patients, with the Rock Hill infusion suite facing patients toward a large glass wall that overlooks a beautiful healing garden featuring palm trees, a large gazebo, and fountain, and the Lancaster suite complete with a glass-domed sunroof ceiling, an indoor fountain, and a large

indoor garden. The traits of both offices helped improve the patient experience by diverting their attention from their discomfort and illness.

Next: We will share the results of our transformation to the OCM.AUTHOR INFORMATION:

The authors are employed with Carolina Blood and Cancer Care Associates of Rock Hill, South Carolina. For correspondence, please address Dr Kashyap Patel, kpatel@cbcca.net.REFERENCES:

1. Patel K, Patel M, Kothadia R, Mehta D, Naidu S, Gor A. Road map to success in the Oncology Care Model: tapping Into human potential via sustained engagement. Am J Manag Care. 2019;25(SP2):SP48-SP49. ajmc.com/contributor/kashyap-patel-md/2018/12/roadmap-to-success-in-the-oncology-care-model-tapping-into-human-potential-via-sustained-engagement.
2. Patient-Centered Specialty Practice recognition. NCQA website. ncqa.org/programs/health-care-providers-practices/patient-centered-specialty-practice-recognition-pcsp/. Accessed March 31, 2019.
3. Oncology Care Model. CMS website. innovation.cms.gov/initiatives/oncology-care/. Updated March 29, 2019. Accessed March 29, 2019.
4. Commission on Cancer Accreditation. Quality improvement. medicalhomeoncology.org/coa/continuous-quality-improvement.htm. Accessed March 31, 2019.
5. Balogh EP, Ganz PA, Murphy SB, Nass SJ, Ferrell BR, Stovall E. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop. Oncologist. 2011;16(12):1800-1805. doi: 10.1634/theoncologist.2011-0252.
6. NCCN Evidence Blocks: frequently asked questions. website. nccn.org/evidenceblocks/pdf/EvidenceBlocksFAQ.pdf. Published 2016. Accessed March 31, 2019.
7. Medicare low-income subsidy: get extra help paying for Part D. National Council on Aging website. ncoa.org/economic-security/benefits/prescriptions/lis-extrahelp/. Accessed March 31, 2019.

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