At Tennessee Oncology, patient engagement technology has boosted remote patient management and streamlined patient-reported outcomes collection.
Value-based care models may be the way of the healthcare future, demonstrating that clinicians can deliver high-quality care at a lower cost. But for organizations to keep pace in this new payment landscape, they’ll need to make meaningful connections with patients and streamline patient-reported outcomes, all in an effort to manage patients outside the care facility.
That much became clear for Tennessee Oncology when the organization joined the Oncology Care Model a few years ago in an effort to bring value-based care to its cancer patient population.
Launched in 2016 as part of the CMS Center for Medicare & Medicaid Innovation (CMMI), the Oncology Care Model presents a bundled payment program for organizations treating patients with cancer. CMS issues real-time monthly payments for better cancer services as well as traditional Medicare fee-for-service payments.
Ideally, the program aims to cut costs and improve outcomes for patients who are undergoing cancer treatment.
And like many of the value-based care models in the industry, the Oncology Care Model requires considerable connection with patients, according to Jeff Patton, MD, Tennessee Oncology’s CEO.
Success in the Oncology Care Model hinges on managing patient symptoms and keeping patients in the lowest cost tier possible. Keeping in close contact with patients and understanding PROs helps clinicians at Tennessee Oncology adjust patient care and intervene when necessary, ultimately keeping patients out of the emergency department and hospital.
“And to manage that, we had to recognize that patients are outside of our clinics probably 95 percent of the time,” Patton told PatientEngagementHIT.com in a recent interview.
Care management is a hurdle for most organizations, as providers work to collect the relevant PROs for specific patient care and to keep track of their patients outside of the clinic. But it’s even more challenging in a rural areas like Tennessee, where patients may live hours away from a clinic and face limitations connecting with their providers.
“Nashville is becoming a pretty big city, but Tennessee gets rural pretty fast,” Patton explained.
He and his colleagues have already dealt with some of those geographic patient barriers to care by opening up around 20 facilities in remote areas of the state.
“We made a decision years ago to leave the big city and take our services into the surrounding community so the patients would not have to drive so far for care and that’s been successful for us and for the patients,” he explained.
But challenges remained. As noted above, patients still spend nearly all of their time outside of the clinic and need an effective mechanism to communicate with their providers and give updates on how they are feeling.
“We needed a better communication platform to help communicate with patients and then to help us internally manage patients and their symptoms and social issues,” Patton stated. “We wanted to manage all of the things that come up that could lead someone to end up in an emergency room potentially inappropriately when that care could have been delivered elsewhere.”
The organization tapped the patient engagement technology Noona, which provides a suite of patient-facing care management and communication functions. The tool, which Patton says was designed with the end-user patient in mind, allows for bi-direction patient-provider communication, offers patient navigation led by nursing staff, and hosts a triage tool for patients presenting with irregular PROs.
The tool is also home to a patient portal, which was a significant draw for Patton and his team. Although Tennessee Oncology had long offered patient access to a patient portal per meaningful use requirements, the tool never garnered any significant staying power, with adoption rates hitting between 5 and 10 percent with previous portals.
But with the addition of all of the different patient engagement functions, Patton said the portal has seen much higher adoption rates, proving its use to the Tennessee Oncology patient population.
Of course, Patton and his team have faced some obstacles and adoption hasn’t been perfect. For one, the organization was surprised to find that many of its patients could not access the new engagement technology because they didn’t have access to a smartphone or a computer.
“When we started this, we had no idea that upwards of half of our patients would not have access to either a Smartphone, a computer, an email address, or the bandwidth to make those usable,” Patton said.
The organization has not yet fully solved that problem, but they are in active conversations with technology providers and other industry stakeholders to close that care access gap.
“One avenue to address it is to at least have devices that they can use when they come to our clinic, but patients are only with us part of the time,” Patton pointed out. “That only solves about 5 percent of the problem.”
Currently, Tennessee Oncology is working with its vendors and some pharmaceutical manufacturers seeking help to underwrite some access to a patient engagement device outside of the clinic, although these talks have not yet materialized into a formal deal.
Nonetheless, Patton and his team are celebrating some victories. For one, the organization has a better grip on its PROs, making it far easier for them to improve quality of life and outcomes for its patients.
“Previously, when patients would do patient reported outcomes, it’d be a survey that’s done every three or four weeks. And due to recency effect, the only patient reported outcomes we got were how the patient felt the day before they came in,” Patton explained.
This is especially problematic among cancer patients undergoing chemotherapy. Due to the nature of the treatment, patients feel their worst about a week or two after the treatment and begin to feel the effects of the treatment three weeks later.
“We’re trying to do more continuous reporting so that we monitor patient symptoms from day one to day two, all the way through the three-week appointment,” Patton said.
Tennessee Oncology does not yet have data related to how better collection of PROs and increased patient outreach has improved its performance in the Oncology Care Model, but Patton and his colleagues do note the evidence revealing a connection between PRO collection and outcomes.
“This is actually not something that we’ve done before and in a systematic way,” Patton noted. “Our PRO collection has greatly improved and there’s actually published literature that when you collect patient reported outcomes, those patients actually have a better outcomes and sometimes survival.”
Going forward, Tennessee Oncology plans to continue its PRO collection and further investigate how it impacts its success in the Oncology Care Model.
Although the organization does not yet have evidence that PROs have helped their clinic specifically, Patton and his team predict that PROs will help providers connect with patients as soon as a patient feels an irregular symptom. This will allow for early care intervention, keeping that patient in that lower cost tier that Patton said is the key to value-based care success.
Date: July 17, 2019