Raising the Bar on Quality Care
We believe that our Oncology Care Management Program; OCMP has the opportunity to create a new standard of care for patients with cancer. The program allows patients, their families, employers, payers and providers to do a better job assisting the patients during this critical time in their lives. At times, providers do not have the necessary staff or time to assist all the needs and questions that patient and their families may have. As well, employers and payers do not have the specialized staff required to support the patients and family’s needs. We will have dedicated team members for each MD practice or multiple practices’ depending upon the patient volume.
Over the past 15 years, we have realized great strides in cancer care; yet, the rapid pace of advancement, an aging population, a shortage of oncologists, and new targeted drugs, often used in combination and for longer periods of time, may, in fact, threaten quality, successful care, and will certainly escalate costs.
SCM provides the expertise to help you and your patients realize improved quality care and reduced treatment costs for these medically complicated, emotionally wrought cases.
Consider these facts:
- 15% of diagnoses are incorrect,
- More than 25% of treatment plans deviate from guidelines,
- 45% of patients do not comply with prescribed treatments,
- 50% – 75% of cancer treatments include off-label drug use that is at risk of being paid when it shouldn’t be or not being paid when it should be.
Oncology Care Management
Our Oncology Care Management Program (OCMP) lends its support, guidance, and education to the patient, caregivers, and family during a critical time in their illness process; right after diagnoses, time of treatment decision, during treatment and after treatment is complete. The program has been designed to work collaboratively with physicians, payers and mainly the patients and their families every step of the way to answer questions, alleviate concerns, help with communication with doctors, track research on clinical trials and new treatment options, as well as, discussions around palliative care and hospice as needed.
Care Coordination and Patient Care Management
- Ongoing care management of all levels of care include
- Creation of a plan of care, interventions, and short and long-term goals
- Patient education and empowerment
- Caregiver support
- Coordination of resources and services
- Telephonic communications
- Group sessions in MD office when appropriate
- Possible home visits if necessary
- Ongoing physician communication
- Case management if the patient goes to the hospital or SNF
- Clinical trial support
Oncology Care Management Study
A member with lung cancer was treated with IV Etoposide. Through our involvement and discussion with the provider and family, we transitioned the individual to an equally effective oral Etoposide. Neulasta was arranged to be given in the home at the appropriate timing maximizing the drug’s efficacy. This drug was given to help limit hospitalizations related to neutropenia.
The patient was directed to in-network providers, saving the plan 32% of billed charges.
The change to oral chemo avoided pharmacy costs and administration costs, yielding savings per day of $532; two days per cycle; saving $1,064 x 10 cycles = $10,640
Direction to in-network facilities for appointments and treatments yielded savings of $1,000
Self-administration of medication yielded savings of $50 per visit; 10 visits avoided = $500 saved;
Estimated two-day hospitalization avoided with increased efficacy of Neulasta, at $2,700/day at primary network rate for hospitalization. Cost Avoided = $5,400
The result was total savings of $19,740 with increased quality of life for the patient.
The SCM Systems
Our Oncology Care Management Program (OCMP) is supported by a powerful information system that drives the care management process from services, such as, low touch (print material) to high touch (face to face care in the physician’s office the patient’s home and community). Our systems have been designed to connect with the health care system – Physicians EMR’s, health plan (claims, authorization and utilization), pharmacy, laboratory, health risk assessment data and more. The system stratifies the population, drives and prompts targeted care management, alerting the physician, pharmacist and care managers to deviations from standard care, potential health hazards, as well as, driving, targeting goals and intervention based care plans.
IntriCare Management System
IT Infrastructure Management connected to clinical outputs
- IT Infrastructure -Integrates with the MD office, lab, pharmaceutical MCO
- Electronic Health Record
- Plan of Care
- Interventions – Clinical Guideline embedded
- Medication monitoring
- Sentinel events
- Monitoring of admissions to hospital, ED, Sub acute and other tertiary facilities
- Transitional care plans and monitoring
- Advance directives
- Laboratory data
Outcome Measures and Reporting
We believe that the most cost and outcome effective approach to developing a fully implemented comprehensive OCMP is to work in collaboration with the physicians, facilities and the payers, connecting their systems, EMR’s and clinical teams within their offices with our robust CM system. This will lead to better care, fewer errors, cost-effectiveness, decreased duplication of services and illustrate to the patients and their families that we are a cohesive team.
Together we can:
- Review patient data.
- Discuss the acuity level of the patients
- Screen patients for the program
- Monitor medications for duplication or error
- Coordinate and monitor resources and services
- Place the patients in the appropriate level of care.
- Support, guide and educate the patients and their families.
This model is a win for all stakeholders.