Building Sustainable Practice Transformation Through Payment Reform Initiatives

Abstract

PURPOSE: Novel value-based payment approaches provide an opportunity to deploy and sustain health care delivery interventions, such as treatment planning documentation. However, limited data are available on implementation costs. METHODS: We described key factors affecting the cost of implementing care improvements under value-based payments, using treatment planning and Medicare's Oncology Care Model as examples. We estimated expected costs of implementing treatment plans for years 1 and 2-6 under (1) different staffing models, (2) use of technology, and (3) differences in the patients engaged. We compared costs to the payment amounts under the Oncology Care Model. RESULTS: Team-based models where staffing is aligned with skills needed for key tasks (eg, a combination of lay navigator, nurse, and physician) are more financially feasible when compared with using physicians or nurses alone. When existing staff are at or near capacity, hiring new staff focused on practice transformation activities allows adequate time for new initiatives without negative impacts on existing services. Investments in information technology can enhance staff productivity, but initial costs may be high. Interventions may not be financially feasible if implemented for a small patient volume or only for patients insured by a particular payer. Finally, costs may be higher for disadvantaged populations, and equity in care delivery may require higher payments from payers. CONCLUSION: Estimating the cost of implementing an intervention in different types of practice settings with various types of patients is essential to ensure that a value-based payment system will adequately support desired improvements in quality of care for all patients.

A randomized controlled trial of shared decision-making treatment planning process to enhance shared decision-making in patients with MBC

“…Importantly, it does not require the oncologists to complete additional work to create or deliver treatment plans. The delegation of different healthcare team member roles (e.g., oncologist reviewing patient-reported data, nurse educating patient) remains important for the financial sustainability of the treatment planning process [ 51 ]. Also, focusing the oncologist role on review of patient-reported data likely contributed to the acceptability found in this study where the treatment planning process was noted to be helpful.…”

Cancer-Related Financial Hardship Screening as Part of Practice Transformation

“…Collection of patient-reported financial hardship data often comes at considerable time and cost, both of which are barriers to real-world data collection and response. Our 88%–90% feasibility rate of capturing these data was due to our almost 10-year-long effort building data capacity to capture patient-reported outcomes and, importantly, subsequent reimbursement via participation in the Oncology Care Model 11 . Practices participating in the next iteration of the Oncology Care Model, Centers for Medicare & Medicaid Services’ Enhancing Oncology Model, will also receive payment incentives for health-related social needs screening.…”

“…Financial hardship screening measures were incorporated into a standard-of-care treatment planning survey implemented as a practice transformation activity required within the Center for Medicare and Medicaid Innovation Center’s Oncology Care Model. 10 , 11 This treatment planning document is generated from survey-based patient-reported data at cancer diagnosis and repeated every 6 months if still receiving treatment or at any treatment change. The treatment plan is embedded into the electronic medical record for provider review and patient education.…”

Learning From Real-world Implementation of Daily Home-Based Symptom Monitoring in Patients With Cancer

“…Thoughtful consideration of workforce costs is needed for implementation of practice transformation activities. 9 Given that Daly et al 7 observed a predominance of within-week shifts being between no alert and a yellow alert, a 1-week recall period may in fact be appropriate with these patients generating yellow alerts for the week. Ultimately, efforts will inevitably be needed to separate alerts needing further management from noise, to both minimize alert fatigue for nursing staff and maximize nursing efficiency, particularly when nursing staff is in short supply owing to the COVID-19 pandemic.…”

“…While this might be feasible at well-resourced, large institutions, many institutions may not have the capacity to accommodate this additional workload. Thoughtful consideration of workforce costs is needed for implementation of practice transformation activities . Given that Daly et al observed a predominance of within-week shifts being between no alert and a yellow alert, a 1-week recall period may in fact be appropriate with these patients generating yellow alerts for the week.…”