Chicago Area Oncologists Partner With CMS on Innovative Patient Care Model

Friday, July 29, 2016

For cancer patients, life can seem overwhelming: juggling appointments, sticking to a medication schedule, adjusting to changing treatment plans and dealing with the physical and mental side effects. They may see several physicians and other medical professionals in multiple settings.

Rush physicians are working to streamline the care process, to help improve both the patient’s experience, and his or her outcome. A new partnership with the Centers for Medicare and Medicaid Services will support this effort.

Physicians from Rush University Medical Group (RUMG) and Rush Copley Medical Group (RCMG) have entered into an innovative program offered that will change the way chemotherapy patients receive services. The physician groups are among fewer than 200 practices nationwide taking part in CMS’ Oncology Care Model, which is aimed at redesigning the way services are delivered to Medicare patients. The goal is to deliver higher quality cancer care services in a more coordinated and efficient way. The OCM program began on July 1, 2016, and runs for five years.

Under the OCM partnership, RUMG and RCMG oncologists will work more closely with each other and with clinicians providing support and wraparound services to offer more integrated care, and decrease unnecessary or duplicative services. Patients will benefit from enhanced navigation services and increased access to care in appropriate settings.

The RUMG and RCMG oncology providers were chosen to be part of the program because their patient-centered care practices support and encourage higher quality, more coordinated cancer care. RUMG and RCMG oncologists see patients at Rush University Medical Center, Rush Oak Park Hospital, Rush-Copley Medical Center in Aurora, Rush-Copley Healthcare Center in Yorkville and at the Medical Center’s facility in Lisle.

The timing aligns with Rush-Copley’s and Rush University Medical Center’s recent announcement of an enhanced relationship that more closely aligns the organizations and will seek to bring academic medicine to the western suburbs.

More access and hands-on assistance

Rush Health, a clinically integrated network of more than 1,400 providers and four hospitals, is coordinating the OCM collaboration. Rush Health is aimed at improving the quality and cost of health care for patients, employers and payers. Since both practices are part of Rush Health, there is an existing structure to standardize treatment, leading to better outcomes and lower costs.

“Ideally people will have more access, with additional hands-on intervention outside normal physician visits,” says Brent Estes, president and CEO of Rush Health. “We will look at navigation and other opportunities for partnership. Everything is on the table.”

The program is similar to the patient-centered medical home model for primary care delivery, which provides a home base for a patient’s medical care. It is the first of its kind to put this focus on a complex condition like cancer.

 According to the National Cancer Institute, 1.6 million people are diagnosed with cancer each year. The cost of treating cancer in the United States was $125 billion in 2010, and is expected to reach $156 billion by 2020.

Program generating ‘a lot of positive energy’

Rush Health will provide a structure for consistent care delivery and quality measures, and data management and clinical support for the practices, while maintaining a uniform framework with Rush Health’s electronic health record. The OCM goals align with Rush Health’s population health model, which aims to increase patient access and engagement while coordinating care to reduce costs and using outcome data to improve quality.

Providers will receive a lump sum payment each month based on the number of patients in the program, and meeting or exceeding quality and clinical improvement goals could result in added reimbursements from CMS. The goals factor in the total medical costs for the patient during each six-month period, regardless of who is providing services. Thus, the program affords an opportunity to collaborate with other providers in patient management, including providers outside the Rush  network.  

“There is a lot of positive energy within the RUMG and RCMC practices around this program that reflects how network and providers are embracing the shift to value-based contracting,” Estes says.