PYA Thought Leader Defines Role of Radiation Oncology in Clinical Integration
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April 24-25, 2014 Prepared for SATRO ® 16 th Annual Conference Clinically Integrated Networks and the Role for Radiation Oncology A Presentation For: SATRO® 16 th Annual Conference April 24-25, 2014
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PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
Transcript of PYA Thought Leader Defines Role of Radiation Oncology in Clinical Integration
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Clinically Integrated Networks and the Role for Radiation Oncology
A Presentation For: SATRO® 16th Annual ConferenceApril 24-25, 2014
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Why Clinical Integration?
• Today’s volume-based, fee-for-service system is based on independence: each provider is paid for providing a discrete service, without regard to others’ performance.
• Tomorrow’s value-based payment systems, however, will demand interdependence: providers will be rewarded for quality and efficiency achieved through collaborative care.
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Fundamentals Driving Clinical Integration
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Adapting to your “Customers” Demands
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Defining Clinical Integration
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Key Characteristics of a CIN
• Well-defined governance structure to promote organizational goals while protecting individual interests
• Physician-driven, professional management
• Data-driven
• Relentless focus on improving the health of the population served
• Adherence to evidence-based medicine guidelines and clinical protocols
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Investing in Clinical Integration as a Strategy
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Demonstrating the Business Case for Clinical Integration
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Understanding Basic CIN Economics
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recognizing the Unique Challenge of Engaging Physicians
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Developing a CIN
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Launching a CIN
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Operating the CIN
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recent Trends in Cancer Care Clinical Integration Strategy
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recent Trends in Cancer Care Clinical Integration Strategy
1. Patient-Centered Medical Home (PCMH) model is becoming increasingly common for oncology to combat the high costs of oncology services.
2. Commonalities Among Top Oncology Programs, such as increasing focus on patient-centered care and cost-awareness.
3. Emerging Personalized, Molecular Treatments’ ability to specifically target molecular abnormalities driving tumors.
4. Genome-based Cancer Care “Arms Race” on patient genome sequencing capabilities to more precisely prevent and treat cancer.
5. Genome (vs. Tumor Site) Driving Future of Cancer Treatment to better treat patients’ specific cancers.
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Patient-Centered Medical Homes
• CMS awarded a $19 million grant to implement PCMH models in seven oncology practices across the U.S.
Background
• Many oncology centers are developing oncology-based medical homes in an effort to improve care and quality while decreasing high costs associated with oncology.
Why PCMH?
• Accessible, comprehensive and coordinated care through a systems-based approach.
• Clinical staff better serve their patients by developing and maintaining an active partnership with them and providing proactive, preventative and chronic care management, which in turn, prevents complications and hospitalizations.
Benefits
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Patient-Centered Medical Homes• Gaps between quality and care delivery standards in oncology could be addressed
by PCMH model.
• PCMH principals could encourage rational utilization of healthcare resources through the use of:
Evidence-based guidelines
Reduced hospitalizations, ED visits, and imaging
Increased engagement with patients, especially for end-of-life care decisions
• The Results Don’t Lie!
Reduced hospitalizations, ER visits, imaging services, and diagnostics
Improved coordination of services, patient communication, and overall efficiency
The practice reduced its staff-to-physician ratio from 8.3 FTEs to 5.5 FTEs and increased its patient base by 30 percent
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Commonality Among Top Oncology Programs
Oncology leaders at the nation’s top hospitals shared 11 trends in hospitals’ cancer care…
Increasing outpatient care
Focusing on patient-centered care
Personalizing medicine through genetic analysis for effective treatment
Increasing cost awareness
Focusing on outcomes by adhering to evidence-based practices
Coordinating care through technology
Offering services which compliment patient’s treatment
Coordinating cancer services to treat the whole patient
Enhancing survivorship programs
Offering palliative care services
Offering more educational opportunities for patients
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Emerging Personalized, Molecular Treatments
Ability to target agents directed specifically to molecular abnormalities driving specific tumors
Yesterday… Today…
Surgery Chemotherapy Radiation
Rough Tools: Personalized Medicine:
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Genome-Based Cancer Care “Arms Race”
• Cancer care providers, particularly academic medical centers, are launching an “arms race” on patient genome sequencing capabilities in order to more precisely prevent and treat cancer. – Johns Hopkins – “systematic genomic sequencing program”
– Phoenix Children’s Hospital – Ronald A. Matricaria Institute of Molecular Medicine
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Genome Driving Future of Cancer Treatment
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Clinical Integration and Radiation Oncology
General Considerations
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Transition to Coordinated Care
• Consolidation of the Hospital Market
– The number of hospitals that are part of a health system has been growing steadily for more than a decade.
– Almost 60% of hospitals are now part of a system.
– Health system executives are increasingly asking their oncology service line leaders to devise plans that promote coordination, collaboration, and more efficient use of resources.
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Transition to Coordinated Care
• Many health systems were created through mergers and acquisitions.
• Consequentially, cancer programs that were once competitors may find themselves part of the same institution, which is a challenging starting point for collaboration.
• Even if the cancer programs are located in different markets, they will likely have different organizational models, physician governance
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Narrow Network Concerns for Cancer Centers
Cancer patients relieved that they can get insurance coverage because of the new health law may be disappointed to learn that some of the nation’s best cancer hospitals are off limits.
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Narrow Network Concerns for Cancer Centers
• The Associated Press surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network (NCCN).
• Only four out of the 19 nationally recognized comprehensive cancer centers that responded to the survey said patients have access through all the insurance companies in their state exchange.
• These patients may not be able to get the most advanced treatment, including clinical trials and medications.
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
The National Benchmark for Oncology, 2013 Report on 2012
Data
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey ResponsesResponse to survey question “Do you expect to be impacted by an ACO [accountable care organization] in the coming year?”
• Practices, 93• Full-time equivalent
physicians, 814
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey ResponsesResponse to survey question “If yes, do you expect to participate in risk/reward with the ACO [accountable care organization]?”
• Practices, 67• Full-time equivalent
physicians, 637
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey ResponsesResponse to survey question “Do the physicians in your practice regularly use practice guidelines or clinical pathways for patient care?”
• Practices, 86• Full-time equivalent
hematology/oncology physicians, 663
• FTE physicians, 812
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey ResponsesSource of clinical pathways
• Practices, 46• Full-time equivalent
hematology/oncology physicians, 304
• FTE physicians, 391
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey ResponsesResponse to survey question “How do you use clinical pathway data?”
• Practices, 43• Full-time equivalent
hematology/oncology physicians, 291
• FTE physicians, 376
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Why Clinical Integration?
• Today’s volume-based, fee-for-service system is based on independence: each provider is paid for providing a discrete service, without regard to others’ performance.
• Tomorrow’s value-based payment systems, however, will demand interdependence: providers will be rewarded for quality and efficiency achieved through collaborative care
April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Christopher Wilson, J.D., M.P.H.Senior Manager
