Oncology medical home: Payer return on investment (ROI).

Abstract

e17582 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.