Background: In June 2016, Rush University Cancer Center (RUCC) entered into an agreement with the Centers for Medicare & Medicaid Services (CMS) to participate in the Oncology Care Model (OCM). This includes providing enhanced services to Medicare beneficiaries receiving chemotherapy within the context of a 6-month episode of care. Each organization participating in the model is provided with an additional per member per month funding amount and encouraged to transform their practices with the shared goal of improving health outcomes and producing higher-quality care at the same or lower cost to Medicare. RUCC has implemented several transformative initiatives, including the development of a dedicated care navigation team and a cancer-specific urgent care center that we found led to a reduction in the proportion of patients using the emergency department (ED), being hospitalized, and who were readmitted within 30 days.
Objectives: To describe the implementation of RUCC’s care navigation program for patients receiving chemotherapy, utilization of bundled interventions, and goal analysis as it pertains to ED/readmission reduction and advanced care planning compliance.
Methods: Approximately 920 Medicare beneficiaries with any type of cancer, on both oral and intravenous chemotherapy, and in a 6-month episode are eligible to participate in the program. The interdisciplinary care navigation team is composed of a nurse, 2 social workers, and a patient care navigator. Utilizing an evidence-based triad care team model, the care navigation team huddles daily to review ED visits and hospitalized patients. Using automated risk assessment tools, team members conduct targeted needs assessments and deep interventions for high-risk patients; these activities go beyond the normal boundaries of the cancer center and assist in navigating patients across primary, specialty, and urgent care settings, conducting transitional care calls, coordinating with community agencies, utilizing Lyft and other transportation services to assist patients in eliminating their barriers to care, etc.
To evaluate progress and impact, the care navigation team reviews claims data provided by CMS called the OCM Practice Feedback Report; the data contain values that are/are not risk adjusted. The team tracks rate of ED utilization, 30-day hospital readmissions, and advanced care planning compliance to better understand the impact of our interventions and areas of optimization.
Results: RUCC reviewed CMS’s Feedback Reports for 2016 and 2017, paying particular attention to the practice’s utilization. For inpatient utilization per 100 beneficiaries, the rate of admissions decreased from 33.9 in 2016 to 30.1 in 2017; unplanned readmissions within 30 days also decreased, from 9.5 in 2016 to 8.1 in 2017. Admissions resulting from an ED visit decreased from 23.4 in 2016 to 21.6 in 2017. Regarding ED utilization, the rate decreased from 16.6 in 2016 to 15.9 in 2017. Based on the aforementioned outcomes, it is important to note the care navigation team’s significant contributions to improving care for the OCM population.
Conclusion: There has been a reduction in ED usage and hospital utilization, showing that the program is directionally effective. RUCC continues to test and monitor the results of this program.
