What is the Logic of an Oncology-Specific Medical Home?

At first glance, it would appear that the concept of an oncology-specific medical home flies in the face of reason by defeating the purpose of a medical home managed by the primary care physician. However, the rationale is seen in the complexity and severity of cancer treatment.

When a person is diagnosed with cancer, in the majority of cases, the treatment of the cancer becomes the primary focus of medical care. Other medical care needs to be coordinated in the context of the primary goal of treating the cancer. In many cases, the patient receives highly specialized treatment, such as chemotherapy and radiation. Chemotherapy and other types of cancer drugs are potentially toxic and require administration at the site of care by specially trained oncology nurses. These drugs can cause serious side effects that need to be treated in the context of the patient’s overall cancer care. Few primary care physicians have the expertise and facilities to administer cancer treatment.

Additionally, primary care physicians are not trained or comfortable with the intensity of symptom management (e.g., related to pain, nausea/vomiting, neuropathy, and blood count management) typically required in providing cancer treatment. As such, because treating the cancer becomes the medical priority, in most cases the oncologist functions as the patient’s primary medical caregiver during the phase of active cancer treatment and follow-up care.

As the medical home for the cancer patient, the oncologist is in the best position to ensure that treatment is optimized and that adverse events are minimized — with a goal of eliminating them based on process improvements. These events include treatment side effects that require additional care and, in cases, can lead to emergency room (ER) visits and/or hospitalizations, which can be detrimental to patient outcomes and substantially increase the cost of patient care.

What is the Oncology Medical Home Model?

The Oncology Medical Home model is about delivering, ensuring, and measuring quality cancer care. In short, it is a patient-focused system of delivering quality cancer care that is coordinated, and efficient. As such, it will be designed to meet the needs of patients, payers, and providers.

Some of the key aspects of the Oncology Medical Home model are:

  • Cancer care that is optimized based on evidence-based medicine to produce quality outcomes
  • Cancer care that is accessible and efficient, with treatment provided in the highest quality, lowest cost setting for the patient
  • Cancer care that is coordinated with the central focus on the patient and their medical condition
  • Cancer care that is delivered in a patient-centric, caring environment that optimizes patient satisfaction
  • Cancer care that is continuously improved by measuring and benchmarking results against other facilities providing care so that best practices “raise the bar” in delivering care

In terms of provider reimbursement, there are several different payment models — modified fee-for-¬service, management fee, episode-of-care, shared savings, etc. — that can be utilized in the Oncology Medical Home model. What is necessary in terms of reimbursement are:

  • A payment system based on results (i.e., quality and value)
  • Payment that is realistic in terms of maintaining the viability of the model
  • A payment system that allows the right care to be delivered at the right time, without hurdles to providing care