Case Study - OMNI HealthcareShifting Oncology Care to a Value-Based Model
In the current cancer landscape, payers and providers want to move to value-based care models. However, there is no clear, consistent definition of what value means in oncology care, and therefore, no business model that supports the transformation to value-based care.
Defining Value in Value-Based Care – Today, payers are challenged to apply and operationalize the available universe of data and standards. Oncology Resource Networks (ORN) conducted market research to establish a definition of “value” representing elements of both cost and quality that span the entire continuum of cancer care. ORN came up with a 10-point index called the Oncology Value Profile™.
OMNI Healthcare Study – ORN partnered with OMNI Healthcare, a multi-specialty clinic in Brevard County Florida, to pilot the application of the Oncology Value Profile to drive improvements in practice performance that translate to value in the form of improved quality and decreased cost of care.
- To operationalize the data collection and mechanics of “scorecarding” providers against the Oncology Value Profile™.
- To diagnose barriers to practice performance and drive targeted improvements against the Oncology Value Profile.
- To monetize “shifts” on the Oncology Value Profile™ to estimate program savings impact at scale.
During the period of study, the oncology practice had 239 patients, 61 receiving chemotherapy, and 358 office visits and consultations. OMNI was originally evaluated in November of 2014.
The initial practice assessment process included the following components:
Advance Practice Survey:
- Practice Demographics (clinical and nonclinical staffing, equipment, physical space, patient care philosophy, etc.)
- Systems Inventory
- Appointment Availability
- Patient Workflow Overview
- Interviews with clinical and non-clinical staff
- “Shadowing” of patient encounters
- System demos (EMR, Practice Management, Scheduling, etc.)
- Data extracts/analysis
- Patient Satisfaction Results (both practice surveys and Healthgrades)
- GPO reports
Practice Scorecard – Based on assessment findings and observations, ORN produced a practice ‘scorecard’ identifying areas of excellence, and areas of opportunity.
OMNI’s baseline Oncology Value Profile™ score was 2.91, placing them in the ‘needs improvement’ category. While the practice ranked well on measures related to patient access and coordination of care, opportunities for improvement included:
- Compliance with evidence-based guidelines
- Consideration of cost
- Patient satisfaction
- Completion of advanced directive
- End-of life management
ORN made a series of recommendations, and assisted the practice with implementation, including:
- Implementation of a patient satisfaction survey
- Implementation of an online clinical decision support tool
- Design and implementation of a formalized chart preparation process
Performance Improvements – At the 30-day checkpoint, OMNI’s score had already improved by 27%, and at the 90-day checkpoint, the score improved a dramatic 91% to a 5.56, comfortably placing them in the ‘meets expectations’ zone.
The biggest gains came from improvements in Patient Satisfaction and Compliance with Evidence-Based Medicine:
- The practice initially did not survey their patient population on their satisfaction with their care team. ORN placed a basic ‘comment card’ survey in the office and began to track responses. OMNI demonstrated 98% overall satisfaction within 90 days.
- OMNI had general awareness of NCCN guidelines, and had a reference binder available in the chemotherapy suite, but was unaware of their overall compliance level. ORN implemented an online Clinical Decision Support (CDS) tool, giving the team access to the most comprehensive library of oncology guidelines available. OMNI’s EBM compliance rate was 100% in the first 90 days.
ORN monetized the value of a single shift in a practice’s value score. Each improvement equates to $1,000 per million members per month in savings to a payer. OMNI healthcare earned 23 shifts in their value score, representing savings of $23,000 per million members per month in this market.
On a population of 50,000 health plan members, total savings was estimated at $3.5 million.