Oncology Care Model

Dinesh Kapur, MD
Associate of Eastern Connecticut Hematology and Oncology Associates (ECHO),
Medical Director of Cancer Services at The William W. Backus Hospital

e nc l Care el C is an inte rate s stem aime at pr vi in i er ualit , m re e ectivel

coordinated oncology care at a lower cost to Medicare. OCM is part of the Center for Medicare and Medicaid
nn vati n C initiative t evel p ne pa ment an eliver m els esi ne t impr ve t e e ectiveness
an e cienc specialt care e m el as currentl ne un re ninet t practices an urteen pa ers
throughout the United States. Eastern Connecticut Hematology and Oncology Associates, PC in Norwich is one of
four practices in Connecticut that has been chosen by CMMI to participate in this new care delivery model. As part
of our commitment to providing enhanced services, , ECHO associates have been developing mechanisms for better
care delivery. These include care coordination, navigation and adherence to National treatment guidelines.

C is an epis e ase m el t at enc ura es i ualit c r inate care is is a five ear pr ect it t e
initial phase consisting of the development of infrastructure. Within an institution this includes implementation of
technology for data capture, patient navigation, and triage pathways, establishing relations with a Care Partner (a
designation for a healthcare professional or company that helps realize the OCM goals), and engaging in shared
decision-making with the patient. This process has led to a transformation in how oncology is practiced. Here are the
highlights of ECHO’s initiatives:

1) A Care Partner is necessary to help us determine
what technology is needed to report and assess our
existing claims data. The Care Partner will also
help us analyze raw data feeds that are received
from CMMI. All of this information is then broken
down in reportable formats so that the practice
may establish baselines and benchmarks on a
national level with other practices.
4) Utilizing data for continuous quality improvement.
n a in in sta e ucati n an practice u les
6) Extending practice hours.
7) Establishing quality and compliance initiatives.
8) Creating an outpatient palliative care program.

2) Establishing nurse navigation in the practice
which will guide patients throughout consultation
and treatment processes. This involves patient
education, follow up phone calls, assessing needs
of the patient and identifying/utilizing existing
community resources.
3) Installing triage pathways and a triage coordinator
ill act as t e first c ntact an ui e in t e
event of an urgent situation or emergency.
9) Expanding our engagement in clinical research
trials.
10) Creating better care coordination with other
providers and service lines.
11) Identifying patients at risk for complications and
employing preemptive interventions to avoid ED
visits and hospitalizations.
continued on page 17

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The initial phase of OCM implementation has been extremely laborious and time-consuming for ECHO. There are
si nificant irect an in irect practice relate c sts attri uta le t t e C pr ect inclu in e tensive epl ment
uman capital t er c sts inclu e tec n l c sts it Care artners, irin ne sta r nurse navi ati n,
triage, billing, treatment nursing, pharmacy as well as redeployment of practice resources towards enhanced patient
care experience. The ECHO practice is paid a small stipend per Medicare patient actively receiving treatment per
month to defray costs of the OCM project; but this payment has fallen far short of our expenses to date. Another
issue that has been challenging is that CMMI itself has metrics that are often changing and practices need to be
nimble in order to be compliant.

We are meeting the challenges of OCM by restructuring multitude of processes in our practice and it has been a
journey that has been rather challenging. The eventual goal is standardization, adherence to guidelines, continuous
quality improvement and data driven care of our patients.

In summary, I would like to reemphasize that this is a meaningful project for improving patient care in the long run,
ut it is ass ciate it si nificant c allen es t ptimall impr ve e cienc an eliver care an is ass ciate
it financial an res urce ur ens g

T HE O P E N J O UR NAL • F AL L 2017 - 17 -