Leading Payment Reform to Reduce Cancer Costs



Photo by Daniel Smyth

About OHC 

For more than 30 years, OHC has been the region’s premier provider of treatments for adult cancer and complex blood disorders, offering a wide range of services, state-of-the-art treatments and leading edge technologies. As the only nationally accredited oncology medical home in Cincinnati, OHC puts patients first by delivering compassionate and convenient care tailored to meet a patient’s medical and personal needs.

 

It is predicted that 1.6 million Americans will be diagnosed and another 600,000 Americans will die from cancer this year. Additionally, it is projected that cancer-related medical costs will increase by 27 percent ($158 billion) by 2020.

The dedicated staff at OHC (Oncology Hematology Care Inc.) understands all too well how cancer shatters lives before calculating the huge financial burden. They understand that the healthcare industry needs to begin eliminating unnecessary and redundant tests and OHC is leading the way in addressing these challenges, creating clinically innovative ways to measure and improve care to maximize patients’ outcomes.

“Cancer treatment can be complicated, lengthy and expensive,” says E. Randolph Broun, M.D., president and chairman of OHC. “As the aging of the population increases and our workforce’s demographics reflect more baby boomers, we need to help families, payers and business leaders manage this aspect of healthcare cost.”

OHC, the Tri-State’s only independent group of specialists in adult cancer and blood disorders, is a national leader in participating in value-based patient-care models.

“We provide a value-based approach that improves care for our patients,” says Dr. Broun. “It allows teams of cancer specialists to collaborate on the diagnosis of a cancer patient at all stages in their life. This model also gives OHC the responsibility to arrange appropriate care that is continuous, proactive and incentivizes physicians to improve the health, affordability and better patient experience.”

By partnering with insurance providers, OHC has been able to strengthen its payment model to ensure patients receive the most cost-effective care. One example of that is shifting current ‘fee-for-service’ models to one based on expected costs of a standard treatment for a specific condition. Total costs were 34 percent lower than predicted during a pilot program with UnitedHealthcare.

OHC’s studies showed that models like this can reduce hospitalization up to 15 percent and reduce drug costs by 10 percent. ”By these initiatives we anticipate such savings will be passed onto employers,” says Dr. Broun.

“As an independent practice, we have the ability to form partnerships and create payment and care models that will have an immediate impact on our patients, their families and our communities,” says Dr. Broun. “We are doing everything we can to ensure that our patients receive optimal care when and where they need it and do so in the most cost-effective manner.”

The Centers for Medicare and Medicaid Services (CMS) selected OHC as one of nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality, value driven and more coordinated cancer care.

“We are delighted to be selected as it aligns with our strategic commitment to be at the forefront of participating in value-based models that improve care,” said Mike Leavy, OHC’s vice president of marketing and business development. 

“This delivery care model will help us improve our patient education, population health management, psychosocial support, medication adherence and other patient navigation activities. We want to provide the best care at the most effective cost and to be the chosen provider of consumers, payers and business leaders.”

By being one of the first CMS physician-led specialty care models, OHC prepares to build on lessons learned from other innovative programs and models from the private sector. Physician practices can receive performance-based payments for episodes of care surrounding chemotherapy for Medicare patients as well as a monthly care management payment for each beneficiary.

 

OHC Oncology Medical Home Model

  • 24/7 access to a clinician with weekend and same-day appointments
  • Nurse phone triage center for symptom
  • management available seven days a week
  • Fully integrated oncology team including
  • financial navigators
  • Nationally recognized clinical trials program
  • OHC leads the most experienced blood and bone marrow transplant unit in the Tri-State
  • Evidenced-based medicine with high quality outcomes

 

 For more information about OHC, please call 888.649.4800 or visit www.ohcare.com.

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