Oncology Medical Home to address challenges in breast cancer care delivery.

Abstract

e16641 Background: Care fragmentation and poor coordination in oncology negatively impact patient outcomes (IOM 2001, 2005). The Patient Centered Medical Home (PCMH) promises improved coordination of primary and chronic care (IOM, 2008). We previously identified unique challenges in breast cancer care coordination (Schink JC, ARM-1162-2010). Here we explored the distinct characteristics of Oncology Medical Home (OMH) which may address these challenges. Methods: 59 semi-structured interviews with: breast cancer care providers (n=26), patients (n=9), executives (n=24) from 5 major payers. Three multi-disciplinary focus groups included a subset of interviewed individuals (n=17, n=25, n=15). Interviews and focus groups were recorded, transcribed and analyzed according to the framework approach. Results: Theme analysis identified 4 unique characteristics of OMH: 1. OMH should have a lead physician—oncologist or breast surgeon (early stage patients)—for the entire episode of cancer care, then transfer survivors to PCMH. 2. Lead physician facilitates the cross-domain care team from diagnosis through survivorship, including surgery medical oncology, radiology, supportive and primary care. 2. Care and team should be managed as a project, with key events sequenced and timed in a plan, by a care project manager (e.g. APN). 4. OMH requires a unique reimbursement model to incentivize team participation and coordination. Patients strongly encouraged the lead physician feature. Providers suggested all OMH features. Half the payers were not certain of specific OMH features, but most recognized the need for a new reimbursement model. Conclusions: Oncology has unique care coordination and reimbursement challenges. An Oncology Medical Home may address these challenges, but should incorporate features distinct to cancer care and be facilitated by redesigned provider reimbursement. Implementation of OMH may be challenging, but could revolutionize care for cancer patients. OMH pilots will inform implementation and dissemination. OMH characteristics Providers Payers Patients Oncologist or surgeon lead physician 73% 46% 89% Cross-domain care team 81% 63% 78% Care project plan 73% 38% 67% Unique reimbursement model 85% 88% 33%