1 Cancer Center Business Development Group, Lighthouse Point, FL.
2 Archway Health, Watertown, MA.
J Oncol Pract. 2019 Feb;15(2):e91-e97. doi: 10.1200/JOP.18.00082. Epub 2018 Dec 21.
Value-based care infers care that is high quality at a comparatively low total cost. A key strategy for value-based oncology care is to avoid unnecessary emergency room (ER) visits and associated hospitalizations of patients receiving treatment for cancer. Early experience with this strategy showed that symptom management in patients with cancer can result in the reduction of ER events and hospitalizations. However, quantifying the actual savings achieved has been elusive. In this article, we present the impact of symptom management and triage pathways programs deployed at two midsize community oncology practices. We then quantify the actual dollar saving in their Medicare and commercial populations.
Symptom management records generated through the ER triage programs at the two practices were screened to identify avoided ER events. This approach was validated with an independent analysis using Medicare claim data from the Oncology Care Model program in which both practices participate. Bootstrap simulations were used to test for statistical significance of the ER event rate changes before and after the launch of the program. Average event and annual total cost savings from avoided ER incidents and ER-related hospitalizations were then calculated.
Two hundred twenty-two avoided ER events were identified, for an estimated net annualized savings generated by the two practices of $3.85 million. Although the ER rate reduction was not statistically significant, these findings are consistent with the observed reduction of ER event rates among a subset of Oncology Care Model beneficiaries at the two practices.
ER events and associated hospitalizations can be avoided as well as quantified as a result of the deployment of a practice-level integrated platform that incorporates physician-scripted symptom management protocols and telephone triage pathways.
基于价值的医疗保健是指以相对较低的总成本提供高质量的医疗服务。基于价值的肿瘤学护理的一个关键策略是避免接受癌症治疗的患者不必要的急诊室（ER）就诊和相关住院治疗。该策略的早期经验表明，对癌症患者的症状管理可以减少 ER 事件和住院治疗。然而，量化实际节省的成本一直难以实现。在本文中，我们介绍了在两家中型社区肿瘤学实践中部署的症状管理和分诊途径计划的影响。然后，我们量化了其医疗保险和商业人群中的实际节省的美元数。
通过两家实践的 ER 分诊计划生成的症状管理记录被筛选以确定避免的 ER 事件。通过独立分析验证了这种方法，该分析使用了两家实践都参与的肿瘤学护理模式计划中的医疗保险索赔数据。使用 bootstrap 模拟测试了计划推出前后 ER 事件率变化的统计学意义。然后计算了避免 ER 事件和与 ER 相关的住院治疗而产生的平均事件和年度总成本节省。
确定了 222 次避免的 ER 事件，两家实践的年化净节省估计为 385 万美元。尽管 ER 率降低没有统计学意义，但这些发现与两家实践中肿瘤学护理模式受益人的 ER 事件率观察到的降低一致。
由于部署了整合了医生脚本症状管理协议和电话分诊途径的实践级集成平台，可以避免 ER 事件和相关住院治疗，并且可以对其进行量化。
