A qualitative analysis of care management based on a large community-based oncology group’s value-based care experience.
Authors: Melinda S. Hill, Lucio N. Gordan, Beth A. Wittmer, T. R. Strickland, Michael Diaz, Nathan H. Walcker, Shehnaz Pancholi, Scott C. Pepper, Karna Sheth
Journal: Journal of Clinical Oncology (2021)

e18653 Background: Florida Cancer Specialists &amp; Research Institute (FCS), a Florida-based physician led oncology group, participates in value-based care (VBC) programs to improve quality of care, reducing waste, unnecessary utilization, and lowering costs. Methods: A focus group of four FCS Care Managers (CM) was conducted by Integra Connect (IC) with the following goals: 1) Discuss CM and current processes; 2) Delineate best practices; 3) Determine improvement opportunities and 4) Quantify CM impact on reducing ED utilization. IC conducted a structured interview of 16 questions with six questions emailed after. The information provided by FCS CM was concordant and analyzed the qualitative data by group. Quantitative analysis compared ED utilization rates (ED visits / 1000 VBC patients) from Baseline (Dec ’15-Nov ‘16) to Year 4, Quarter 3 (thru Aug ‘20). ED utilization data sourced from VBC sponsor’s reports. Results: VBC patients are identified upon intake and follow specific longitudinal care-plan protocols. All patients are extended a personal CM invitation but can elect to decline. In 2020, CM was organized regionally to improve local relationships and build trust between patients and FCS oncologists for symptom management and emotional support. CM works to improve quality of care by communicating patient needs to oncologist and primary care provider; clarify treatment plans; expanding telehealth consults (dietitians, behavioral health therapists); and use proprietary resource tool. These types of services may reduce ED visits due to treatment side-effects and underlying disease. CM incorporates proven protocols that assesses a full patient medical history overview, which include but not limited to specialty care, pain management, fall prevention, physical symptoms, mental health, which all contribute to lower ED utilization. One example of CMs intervention includes notifying the on-call oncologist of any shortness of breath, chest pain, fever. CM contacts ED in advance with patient summary. If not an emergency, CMs assessment may result in the patient coming into the office. Quantitative analysis of FCS VBC data from Baseline to Year 4 showed ED utilization decreased 14.9%, with a consistent Year over Year decrease ( R 2 = .90). Conclusions: FCS’ CM processes have evolved over five years with the support of their leadership. Managing patient’s symptoms early rather than later results in better quality of care and reduced ED utilization. Collaboration between CM, patients, and physicians is key to the program’s success. Limitations may include developing customized protocols by provider in regional locations, geographic influence on communication success. Opportunity exists to expand telehealth to better serve geographically disparate populations. ED notification to the oncologist may improve the quality of care and follow-up for patients who do have an ED visit.