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Lessons from an oncology medical home collaborative
1AVP Medical Affairs, Priority Health, 1231 E Beltline NE, MS 1255, Grand Rapids, MI 49525, USA. john.fox@priorityhealth.com
The American Journal of Managed Care
|March 7, 2013
Summary
The Oncology Medical Home model restructures cancer care payments, aligning them with patient outcomes. This patient-centric approach improves care quality and reduces costs by rewarding oncology teams for better health results.
Area of Science:
- Oncology
- Health Economics
- Healthcare Management
Background:
- Current cancer care payment models often create misalignments between financial incentives and patient health outcomes.
- Oncology pathways programs exist but can be enhanced through practice-specific preferred regimens.
- Practices are often financially dependent on drug margins, impacting care decisions.
Purpose of the Study:
- To demonstrate an effective working model for restructuring cancer payments and care delivery.
- To enhance existing oncology pathways programs with practice-specific preferred regimens.
- To eliminate financial dependence on drug margins and align payments with patient outcomes.
Main Methods:
- Implementing a patient-centric approach to cancer care.
- Creating practice-specific preferred regimens within oncology pathways.
- Restructuring payment models to eliminate financial dependence on drug margins.
- Enhancing practice payments for cognitive services provided by the oncology team.
Main Results:
- The Oncology Medical Home program provides an effective model for cancer payment and care restructuring.
- The model eliminates financial dependence on drug margins, aligning payments with outcomes.
- Practice payments are enhanced for cognitive services, rewarding improved patient care and reduced healthcare utilization.
Conclusions:
- Provider-payer partnerships are essential for evaluating experimental payment models.
- Greater provider accountability for Triple Aim outcomes (patient experience, health outcomes, cost) can be achieved.
- The Oncology Medical Home model offers a patient-centric approach to improve cancer care and reduce costs.
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