New Roadmap for High-Quality Cancer Care Delivery

The newly issued comprehensive ‘Oncology Medical Home’ standards can act as a roadmap for how practices can deliver high-quality cancer care.

“Every single patient has the right to high-quality, evidence-based, and cost-effective cancer care,” said Everett E. Vokes, MD, current president of the American Society of Clinical Oncology (ASCO).

“However, our challenge as clinicians and as a broader oncology community has been to define what that high-quality cancer care looks like.”

“These new, comprehensive standards will remove ambiguity and serve as a strong foundation for all stakeholders to work together to ensure that every single person receives the care they deserve, throughout the entire patient journey,” he said in a statement.

The new standards, issued jointly by ASCO and the Community Oncology Alliance (COA), were published online July 13 in JCO Oncology Practice.

‘Oncology Medical Home’ is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement.

Its origins go back to 1967, when the American Academy of Pediatrics introduced the Patient-Centered Medical Home (PCMH), with a goal of improving coordination of care to pediatric patients with special needs. This model was increasingly adapted by specialists in family medicine and, in 2007, the Patient-Centered Primary Care Collaborative (PCMH) was created. In the years that followed, the PCMH came to be regarded as a system for healthcare transformation.

In oncology, the program dates back to 2012. At that time, ASCO launched a new initiative, developed in collaboration with Innovative Oncology Business Solutions Inc (IOBS), which pioneered the model under its Community Oncology Medical Home (COME HOME) program. This pilot COME HOME program implemented specialty medical homes in seven oncology practices across the country.

Subsequent models had some modifications. For example, an early OMH effort was tied to an alternative payment model, with incentives to improve value for patients with cancer undergoing systemic therapy.

Need for Quality Care Model

The COA also developed an Oncology Medical Home, beginning some 9 years ago. “We had a certification program with five standards and 16 measures, and it lasted for 3 years,” Bo Gamble, director of strategic practice initiatives at COA, told Medscape Medical News.

The OMH accreditation model was implemented by the American College of Surgeons’ Commission on Cancer, but “it was crickets for 3 years,” he said. “The practices in the pilot were excited about it, but we really don’t know what happened.”

Gamble explained that ASCO approached the COA about 3 years ago with the idea of working together. “At that time we counted about 35 different cancer care programs that were ongoing in the US,” he said. “They were all different in their methodology and measures — in four states there were seven models.”

Thus, it was confusing to figure out what models were being used and how well they were working. For the current standards, Gamble explained that they spoke with practices and payers, to see if they could all agree on criteria for one high-quality cancer care model.

Standard of Care

To develop the new standards, an expert panel was convened and conducted a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans. Using this evidence base and an informal consensus process, a set of OMH standards was developed.

The new standards feature seven domains of cancer care:

Patient engagement and empowerment to share in decision-making about their cancer care, including individualized treatment plans, survivorship plans, and access to financial navigation.
Patient access to cancer care at the right time and in the right setting. Clinicians should employ a symptom triage system and offer expanded access to timely office care to minimize emergency room visits.
Evidence and value-based treatment. Clinicians should adhere, as well as document their adherence, to comprehensive clinical pathways that reflect the latest clinical research, and as appropriate, recommend and refer patients to clinical trials.
Patient access to equitable, comprehensive, and coordinated, team-based care. Oncology care teams should closely coordinate care, which should include patient navigation, psychosocial care, and support services. Practices must have policies in place to address health equity, including awareness of conscious/unconscious bias.
Continuous-practice quality improvement using data, including patient surveys and patient-reported outcomes, to evaluate and improve processes and outcomes.
Patient access to advance care planning discussions, palliative, and end-of-life care.
Practice adherence to the highest-level chemotherapy safety standards (as per QOPI Certification Program Standards)

Right now, there are eleven practices that have come on board, and the 2-year pilot began on July 1. “We want to be a source of encouragement; we’re not here to police them,” Gamble commented “We have some tough challenges, but this makes sense and we can make it happen.”

Of course, there are some issues in oncology that will take more than an OMH model to resolve, such as the high costs of much cancer treatment.

“But we have proven that if you follow pathways, you can control some of the prices,” Gamble said. “We don’t want a payer formulary, we want a pathway that recognizes quality and value and here we are demonstrating how we can work together on this.”

JCO Oncology Practice. Published online July 13, 2021. Full text

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