CHCWM/Priority Health Oncology Medical Home

1. CHCWM/Priority Health Oncology Medical Home March 6, 2013

2. Cancer and Hematology Centers of Western MI • Single Specialty Private Practice Centered in Grand Rapids • Multiple offices and clinics north to Reed City, South to Hastings, including Lakeshore cities of Holland, Muskegon, Ludington, Manistee • 15 physician, 16 physician extenders, 280 employees • 5000 New patients per year • 80,000 annual visits • Exclusive partner for Spectrum Health and Trinity Health W. MI

3. Program Components • Payment Methodology Reform • Treatment by Pathway • Medical Home Status • Advanced Symptom Management • QOPI Certification • Advanced Care Planning

4. 1) Payment Methodology Reform • Drug revenue goes to break even • New billable codes: • Monthly case management fee • Payment for treatment planning • Payment for advance care planning • Payment for telephone management

5. 2) Treatment by Pathway • Calls for treatment pathway for lung, colon, breast • New order forms are being created to reflect data requirements • Phase II (date TBD) - Online order entry system • NSCLC Example  • Pathway teams include: • Dr. Santos, • Dr. Vander Woude, • Dr. Lakhani, • Dr. Kakarala, • Dr. Gribbin

6. 3) Medical Home Status • Become a certified medical home • For practice: standardizing work across providers and sites • Features: • “Call Me First” • Same day availability for urgent patients • Enhanced patient education program • EMR with rapid communication between specialist and PCP

7. 4) Advanced Symptom Management • Managing the phones: 24/7/365 • Provide evidence based advice for symptom management • New phone triage templates going into effect March 11 • Reduce ER visits and direct admits by providing outpatient alternatives to ER visit • A self-learning system

8. 5) QOPI CertificationThe Quality Oncology Practice Initiative • Practice is a member of QOPI project and will become certified in the next 12 months • QOPI team includes: Dr. O’Rourke and Dr. Batts

9. 6) Advanced Care Planning (ACP) Goal: To initiate discussion with patient and family about: • Choosing a healthcare advocate • Identifying end of life preferences • Completing an Advanced Directive • Pilot results support this being acceptable and valuable to our patients • ACP team includes: Dr. Alguire and Dr. Porter

10. 6) Advanced Care Planning:Late Stage Cancer Program • Program consists of: • Behavioral Oncology service • Focus on the meaning of having an incurable disease and discuss goals and desires for remainder of life • Advance Care Planning service • Social Work service • Focus on resources for end of life • Orderable item in Touchworks • Information provided to patient at scheduling

11. Expected Outcomes • Medical Oncology becomes convener of the team • Optimum evidence-based care delivered in a standardized fashion • Develop evidence where it does not exist • ER and admissions decreased • Quality improves and cost becomes standardized

12. Implementation and Timing • Advanced Cancer Planning: Available to order now • Breast, Colon and Lung pathways: March 11 • Phone Triage (two phases): • 1) Daytime: March 11 • 2) After-hours and weekend: July 1 • QOPI Certification: Application Fall 2013, for Spring 2014 certification approval • Oncology Medical Home Priority Health pilot completion: February 2014