Originally published by Dr. Pamela Spain to the RTI Center for Healthcare Advancement's blog on July 12, 2019
In November 2017, staff in my division were asked to write a haiku poem that describes our research at RTI. Always a fan of the fun haiku, I took a deep breath and wrote the following:
Cancer researcher
Works to improve chemo care
Now receives chemo.
I have so enjoyed
Telling my oncologists
About my research,
And watching as their
Eyes widen and faces smile
When I say I work
To implement and
Monitor models that are
Designed to improve
Quality of care
And reduce health care costs for
Medicare patients
Who have cancer and
are marching their own journey
towards survivorship.
A health services cancer researcher facing a cancer diagnosis was a hilarious twist of fate. I wrote this haiku the day after completing my third of 16 rounds of chemotherapy for advanced breast cancer. Next up was bilateral mastectomy followed by 30 rounds of radiation therapy. Throughout my breast cancer journey, I was strangely calm and energized and I chalk that up to many things, including my personality, my support system, my care team, and my employer.
However, one of the biggest reasons I was unwaveringly positive in the face of such a scary unknown was due to my current work as a health services cancer researcher. I am intimately involved in much of the cancer care reform efforts being driven by the Center for Medicare & Medicaid Innovation (CMMI). The Innovation Center, within the Centers for Medicare & Medicaid Services (CMS), has a growing portfolio of payment and service delivery models that aim to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system.
As Project Director for the Oncology Care Model (OCM), CMMI’s first specialty care alternative payment model (APM) for cancer care, I lead a team of researchers who helps CMMI implement and monitor the OCM. Practices are paid a monthly enhanced oncology services payment for their Medicare patients undergoing chemotherapy. These payments are to help drive practice transformation, hire oncology patient navigators and social workers, and develop a care management plan for patients, including survivorship plans. OCM is a multi-payer model and 14 private payers are participating along with Medicare, including Aetna, Cigna, and Blue Cross Blue Shield of numerous states, among others. Both public and private insurers are recognizing the value of quality-based reimbursement for the delivery of cancer care and are helping create a rapidly evolving field that is improving patients’ lives.
Daily through my research, I see the innovative practice improvements being made in cancer care. I see lives are being saved by practices that are redesigning their care processes. I see the exponential increases in FDA approvals of novel chemotherapy drugs that not only improve survival, but also help patients maintain a high quality of life. I see how patients’ experiences are improved by their interactions with the care navigators, social workers, behavioral health providers, and other members of the cancer care management teams because of the focus on providing high quality, comprehensive, coordinated care.
"I see lives are being saved by practices that are redesigning their care processes. I see how patients’ experiences are improved by their interactions with members of the cancer care management teams because of the focus on providing high quality, comprehensive, coordinated care."
Like CMMI’s other APMs, OCM is steering providers away from being paid for high-volume so that patients receive higher quality care and costs to the health care system are lowered. My team helps CMMI decide what quality metrics chemotherapy centers should be held accountable for and paid for in the value-based OCM. These quality metrics include assessing patients’ pain and developing a plan of care for that pain, screening for depression, and reducing patients’ visits to the emergency room.
During my chemo
I spiked a high fever, and
Called my chemo doc
Rather than go to
To the ER. My doctor
Saw me right away.
It was only strep.
I got better care, at a
Lower cost. And also,
Every visit to
My oncologist for care
He assesses pain.
Recently I said
“I have some bad pain,” and now
My pain is managed.
On the horizon is CMMI’s proposed value-based payment model for radiation therapy, the Radiation Oncology Model. This is expected to be CMS’s first mandatory APM for cancer care. The proposed rule indicates that, like OCM, it will reimburse for high-value radiation therapy care, and providers will be held accountable for metrics that improve the lives of cancer patients receiving radiation therapy.
Coupled with the cancer care reform efforts of CMMI, there is ever-growing enthusiasm in the private sector health insurance market for value-based care reform as private payers are developing and launching their own models of value-base care for cancer. For example, in 2018 Blue Cross Blue Shield launched its “BlueDistinction® Centers for Cancer Care” initiative, that recognizes providers that demonstrate expertise in delivering quality cancer care safely, effectively, and cost-efficiently. There are currently over 300 cancer centers in the U.S. with this highly respected designation that acknowledges cancer providers’ commitment delivery of patient-centered, evidence-based cancer care. Also, this year Humana announced its own national Oncology Model of Care (OMOC) program that will provide compensation for enhanced care navigation based several cancer care components, including inpatient admissions, emergency room visits, medications, laboratory and pathology services, and radiology.
Of course, it remains to be seen what the ultimate impact of these cancer care reform models being developed and implemented by public and private payers will be on patient outcomes and quality of life broadly. However, my first-hand, eye-opening experience with the practice transformation activities that are happening in cancer centers leads me to believe more than anything else that we are in the golden age of cancer care.
"My first-hand, eye-opening experience with the practice transformation activities that are happening in cancer centers leads me to believe more than anything else that we are in the golden age of cancer care."
I lamented to my oncologist how I wish I hadn’t waited so long for my mammogram because I could have been diagnosed many months prior. My oncologist told me, “You are better off being diagnosed today than you were yesterday or the day before.” Oncology care is improving at an exponential pace. Cancer is becoming less of a death sentence and more of a chronic condition to be managed long-term. For this, I am excited and beyond grateful, both for myself and for the other patients who will benefit from all the promising oncology care transformation efforts in the U.S.
One year ago I
Finished my active treatment.
Life’s somewhat normal.
My research goes on
I keep working to improve
Quality of care
For those just like me,
Who face a life-altering
And scary journey.
I am humbled to
Have straddled both sides of the
Oncology coin.
A researcher first,
Then a patient with first-hand
Oncology care.
On the other side
Of my journey, I feel like
My old self, yet not.
Because my journey
Changed me for the better, I’m
A whole new person.