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Cancer Patient Care Coordination Key to Medical Home Program

Blue Cross Blue Shield of Illinois and the University of Chicago Medicine launched an oncology medical home program to improve patient care coordination.

- Blue Cross Blue Shield of Illinois (BCBSIL) has partnered with the University of Chicago Medicine to establish the oncology intensive medical home program, which aims to improve patient care coordination and chronic disease management initiatives for cancer patients, the two organizations announced on Tuesday.  

A new oncology intensive medical home program in Illinois aims to improve patient care coordination

In efforts to promote more value-based care, BCBSIL will allow some PPO patients to receive chemotherapy for specific cancer diagnoses, including breast, colon, lung, pancreatic, prostate, and non-Hodgkin’s lymphoma cancers.

“Healthcare is moving away from a model where we are simply paid for what we do to one where we are held accountable for the quality of care we provide,” said Blase Polite, MD, MPP, Associate Professor of Medicine and Chief Quality Officer.

“The University of Chicago Medicine prides itself on achieving the highest quality of care," he continued. "This agreement allows BCBSIL and University of Chicago to work together to show how a cancer payment model built on quality of care can work to both lower costs and improve patient care.”

The oncology intensive medical home program was designed to provide higher quality care at more cost-effective prices, reported the press release.

Through the new medical home care model, healthcare providers would be reimbursed for services provided based on meeting quality and performance measures rather than the traditional fee-for-service payment model.

BCBSIL and the University of Chicago Medicine also intend to increase patient access to care and improve care coordination through the cancer-specific medical home. Under the program, healthcare providers would be required to use established evidence-based medical treatment guidelines.

“In conjunction with the oncologists at UCMedicine [University of Chicago Medicine], we will be utilizing the latest evidence-based treatment protocols that will improve the quality of cancer care for our members," said Opella Ernest, MD, Divisional Senior Vice President of Health Care Delivery and Chief Medical Officer for Blue Cross and Blue Shield of Illinois.

“Clinical pathways like the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) incorporate the evidence from clinical studies and the recommendations of research scientists into treatment protocols for the various types and stages of cancer.”

The first oncology intensive medical home was launched by BCBSIL in the beginning of the year with Illinois Cancer Specialists. However, BCBSIL has developed several other medical home programs in Illinois that mostly covered primary care physician groups.

Recently, the insurance group has created more specific patient-centered medical home initiatives in hospitals, small primary care practices, and specialty offices, including a specialty intensive medical home program with the Illinois Gastroenterology Group.

By establishing specialty medical home programs, BCBSIL could be closer to achieving its goal of providing quality care at more affordable prices.

Last year, researchers revealed that chronic disease patients cost about 17 times more than other patients, according to a study in the American Journal of Managed Care. Healthcare costs could continue to rise without proper patient-centered care models in place.

Another recent study also reported that inadequate patient care coordination can cause average healthcare costs for chronic disease management to rise by $4,500 over three years. The same patients who experienced care fragmentation were also more likely to undergo an undesirable event caused by gaps in treatments, such as an avoidable hospital admission.

“According to the fragmentation hypothesis, care delivery too often involves multiple providers and organizations with no single entity effectively coordinating different aspects of care,” explained the study.

“Poor coordination across providers may lead to suboptimal care, including important healthcare issues being inadequately addressed, poor patient outcomes, and unnecessary or even harmful services that ultimately both raise costs and degrade quality.”

Through medical home programs and other value-based care initiatives, healthcare stakeholders could help cancer patients survive and manage the deadly disease by improving patient outcomes and reducing healthcare costs.

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