Download Next Steps in Oncology Payment Reform for Established Provider

Next Steps in Oncology Payment
Reform for Established Provider &
Payer Teams
Community Oncology Alliance Conference
April 23, 2015
Presented By: Robert Baird
CEO, Dayton Physicians Network
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Multi-Specialty Group Practice
•
15 Practice Locations:
o 4 Urology offices
o 1 Radiation Oncology office
o 2 Medical Oncology Offices
o 1 Pathology Office
o 1 Business Office
o 6 Comprehensive Cancer Centers
•
43 Physicians and Mid Level Providers
•
317 Employees
•
40,508 Individual Patients
•
231,412 Patient Visits
•
538,084 Phone Calls
Hem/Onc
Urology
Pathology
Imaging
Dayton
Physicians
Network
Radiation
Focus On Quality and Innovation
o CMMI Grant Funded Oncology Medical Home Practice
o United Health Care, Episode Fee Payment Program Participant
o Anthem Quality Care Program Participant
o Aetna OMH Pilot Program Participant
o National Radiation Oncology Registry Program Participant
o CMMI Oncology Care Model (LOI submitted)
Payment Reform (Payer attributes)
o Rewards / supports value (high quality, lower cost)
•
•
Pathways / Evidenced base care
Appropriate case setting
o Expedited Pre cert / Pre authorization process
•
Operational efficiency
o Transparency / sharing of data
Collaborative Relationships
o Increased market share
o Maximize patient experience
o Reduce out migration
Medicare Data July 2011 – July 2012
Dayton Physicians Network Cancer Care
o 37% Fewer In-patient Visits
o 48% Shorter LOS
o 24% Fewer ED Visits
o 16% Reduction in Total Costs
56%
*Number of
chemo pts
visiting ED
$800
63%
*Average cost
of cancerrelated ED
visit
*Number of
ED visits
resulting in
admission
$22,000
*Average cost
of cancerrelated
admission
Opportunities in Cancer Care
*The Advisory Board Company – 27863 Urgent Care for Cancer Patients in 2013
Future
o Getting focus off (for physicians) the drugs and decrease
reimbursements (not the answer)
o Attempts to link value and reimbursement
o Risk = skin in game
o Patients already have skin in game with increase in deductions /
co-pays and in future, decrease in employee spend but defined
contributions.
o Best value for money spent