Costs for end-of-life care for cancer patients may be reduced with oncology medical home, patient navigation, and palliative care models, resulting in new initiatives such as the Centers for Medicare and Medicaid Services (CMS) Oncology Care Model, according to a study published in Health Affairs.1
Of the three models that received Health Care Innovation Awards from the CMS, the oncology medical home and patient navigation initiatives provided the best cost reductions.
According to the study’s findings, the oncology medical home was associated with a decreased cost of $3,346 per person in the last 90 days of life and fewer hospitalizations in the last 30 days of life (57 per 1,000 people). The patient navigation model was associated with decreased costs of $5,824 per person in the last 90 days of life, and also fewer hospitalizations in the last 30 days of life (40 per 1,000 people). The patient navigation provided another benefit: fewer emergency department visits and hospitalizations in the last 30 days of life. Those in this program were more likely to be enrolled in a hospice program for the last 2 weeks of life.
Cancer is an expensive disease, from time of diagnosis on. Efforts to reign in the costs have been difficult and while discussing costs may seem uncaring when talking about people with cancer, these initiatives not only help reduce costs, they improve quality of life for both the patients and their families. Care directed to the needs of dying patients allows them to focus on palliative care and spiritual support, rather than tests, treatments, and hospitalizations, according to an article published on AJMC.com.2
Oncology Medical Homes
Seven oncology medical homes were opened across the United States as part of the Community Oncology Medical Home (COME HOME) model, as the result of a grant from the Center for Medicare & Medicaid Innovation (CMMI) to develop a community oncology medical home model. They were based on three key principles (triage pathways, enhanced access to care, and evidence-based diagnosis and treatment pathways) that allowed patients to manage their illness as long as possible in the home environment or in outpatient settings.
Care through this program showed good early results, with an overall reduction in cost of care of 7.2%. The rate of inpatient hospital admissions was reduced by 12.5%, 30-day hospital readmissions by 11.7%, and emergency department visits by 6.6%.
The Patient Care Connect Program (PCCP) originated from the University of Alabama at Birmingham in 2012. “The goals of the program are to reduce unnecessary emergency room visits and inpatient intensive care unit days, encourage evidence-based clinical pathways, adopt earlier use of hospice care, reduce use of chemotherapy in the last 2 weeks of life, and provide the highest quality of life for people diagnosed with cancer,” Edward Partridge, MD, director of the UAB Comprehensive Cancer Center and principal investigator of the study, said in a release.3
The program was introduced at 12 sites in Alabama, Florida, Georgia, Mississippi, and Tennessee. Nonclinical navigators helped guide patients and their families to appropriate care resources, and helped them communicate their concerns to healthcare providers. An observational study based on this program found that among the patients with patient navigators, hospitalization rates dropped from 35.8% to 16.1% compared with patients who did not have navigators, with rates that went from 10.8% to 7.5%. Visits to the emergency department dropped from 30.7% to 21.8% in the navigated patient population, compared with 14.6% to 13.7% in the non-navigated group. There was a dramatic reduction in intensive care unit admissions (10% to 4%) in the navigation group, compared with the non-navigation group (2.5% to 1.7%).
The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program was developed at the University of Virginia. It is a phased intervention that integrates outpatient palliative care into cancer care. According to a study published in the Journal of Palliative Medicine, “CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups.” The authors noted that only about a half of patients with incurable cancers were referred to the program, however.4
- Colligan EM, Ewald E, Ruiz S, et al. Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending. Health Aff (Millwood). 2017 Mar 1;36(3):433-440.
- Mattina C. Oncology Medical Homes, Patient Navigators Improved Quality and Saved Costs at End of Life. AJMC.com. 2017 Mar 13.
- UAB Medicine. UAB Patient Care Connect Program Results in Cost Savings for Cancer Patients. 2015 June 3.
- Blackhall LJ, Read P, Stukenborg G, et al. CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic. J Palliat Med. 2016 Jan;19(1):57-63.