Aetna Inc.’s latest value-based care arrangement is an oncology medical home with the University of Chicago Medicine that started July 1. As the insurer continues its transition from a fee-for-service approach, drug the groups hope to impact increasing health care costs, viagra inefficient care and redundant services.
The model will automatically be in effect for Aetna members treated at UChicago Medicine, with an initial focus on three cancers: breast, lung and colon. However, Michael Kolodziej, M.D., Aetna’s national medical director for oncology solutions, notes that “the analytics have been built to accommodate all cancer types. The challenge is that for rare tumors it is tough to analyze the data. But we will be expanding the cancers we look at in the program.”
The major support that Aetna provides UChicago Medicine is data, says Kolodziej. “We have built an analytic tool that allows us to provide a snapshot of cancer care as viewed by the payer.…We can focus on a specific cancer type, specific areas of resource utilization, and then, in collaboration with the team at the University of Chicago, look at the specific opportunities for improving care.”
According to Walter Stadler, M.D., professor of surgery and medicine and chief of the section of hematology/oncology at UChicago Medicine, “We’ll be working with Aetna as we analyze our treatment trends and try to learn where we can improve. For example, we already have very good data regarding hospitalizations and ER visits at the University of Chicago. But we often don’t know when our patients show up at outside institutions. Now, with data from Aetna, we will have complete information on these patients.”
Clinical Pathways Are Used
“Our physicians and nurses who have expertise in these cancers devote their practice and academic pursuits to these diseases,” explains Stadler. In creating clinical pathways, “they provided their assessment of the current highest standard of care, including the incorporation of clinical trials.”
“We believe compliance with evidence-based pathways is a critical component of success,” maintains Kolodziej. “In our relationships with community oncologists, we require use of a pathways tool, though we do not dictate a specific tool.”
But in Aetna’s arrangements with academic centers, “where there is clinical expertise, we will accept the pathways developed by the institution,” he says. “However, these must meet two important characteristics: (1) There must be a process for evidence evaluation, and presentation of this evidence to doctors at point of care, and (2) there must be measurement and reporting. Accordingly, we strongly encourage all partners (academic or otherwise) to take a close look at the pathways programs that are out there.”
Kolodziej acknowledges that “building and maintaining pathways is a lot of work. Since most of our practices have not used pathways in a rigorous fashion, we anticipate there will be a learning curve. Our agreements do not set an absolute performance threshold; rather, they require improvement over time with a goal of 80% compliance.”
Although Aetna does not have a specific return on investment expected with this program, Kolodziej tells VBC that the insurer does have multiple goals: “First, we want to reduce unnecessary ER and inpatient stays. Second, we want to improve end-of-life care. Third, we want to identify and broadcast best practices. Fourth, and perhaps most importantly, we want to build a collaborative relationship with some of the best academic medical centers in the country around defining the value they bring to the health care system and to Aetna members. We have a devoted team including contracting and analytical support. Aetna is transforming the health care system by moving away from ineffective models to one that supports value and places the patient at the center of care. Our efforts have been enthusiastically supported by Aetna leadership.”
Out of the approximately 23.7 million medical members that Aetna serves, about 5.8 million “receive care from doctors committed to the value-based approach, with approximately 30 percent of Aetna claims payments going to doctors and providers who practice value-based care,” says the insurer. “Aetna has committed to increasing that number to 50 percent by 2018 and 75 percent by 2020.”
Aetna Has Similar Arrangements
The partnership is not the first oncology medical home arrangement into which Aetna has entered. For instance, since 2013 it has worked with Pennsylvania’s Consultants in Medical Oncology and Hematology, PC, which was the first oncology practice that the National Committee for Quality Assurance (NCQA) recognized as a level III patient-centered medical home. And in April Aetna said it had launched an oncology medical home in February with Moffitt Cancer Center in Florida.
According to Kolodziej, Aetna “has been working on an advanced care delivery model, the oncology medical home, for the last three years. Most of the work has been with community oncology practices. Last year, Moffitt Cancer Center in Florida approached us. They had started some work with another payer and were looking for a multipayer model, and we were able to adapt the oncology medical home model so that we could take advantage of their capabilities as a comprehensive cancer center. We have continued to refine this cancer center adapted model and have been looking for other interested partners. The University of Chicago was identified by the local Aetna market as a good potential partner. After some early discussions, we found our views on oncology care reform to be quite compatible and were able to enter into this relationship.”
Stadler tells VBC that UChicago Medicine is “delighted to work with a payer that shares the same vision to improve the quality of the patient experience and outcomes for cancer patients.”
The collaboration with Aetna, he says, “is part of our ongoing efforts to further enhance our cancer care and provide the highest quality, patient-centered care for these complex diseases, which are so stressful for patients as well as their families.”
Accreditation Is in the Works
For UChicago Medicine, “putting this arrangement together has prompted very fruitful discussions amongst providers, faculty, administrators, operational experts, payors and financial experts in our academic health center. That, in turn, has allowed us to bring a very diverse expertise to bear on the shared goal of improving patient-centered care.”
Kolodziej notes that as of now, certification of oncology medical homes doesn’t exist. NCQA has “a subspecialty certification model, but it is really not oncology specific and has not been embraced by practices that are undergoing transformation.” However, he points out, “the American College of Surgery Commission on Cancer is developing an accreditation program. They have a lot of experience in this space — they accredit hospital cancer programs — and we have been in discussion with them about their measures and process. As this process unfolds, we will assess how to incorporate it into our program.”
For its part, UChicago Medicine has hit the ground running. Stadler tells VBC that this arrangement “is our first foray into oncology medical homes, but we have also submitted an application with the Center for Medicare and Medicaid Innovation” for its five-year experimental Oncology Care Model that will start next year (VBC 3/15, p. 1).
By Jane Anderson
Original article: http://aishealth.com/archive/nvbc0815-08