Bringing population health strategies to oncology

Three years ago, Allina Health, a nonprofit health system that operates 10 hospitals and more than 90 clinics in Minnesota and western Wisconsin, decided to invest in cancer care by putting the focus on population health. According to Mike Koroscik, Vice President, Oncology, Allina Health Cancer Institute (AHCI).

On Friday, Koroscik provided an update on the progress of this process for AHCI, which was launched in October 2021. Koroscik presented Preparing for population health in oncology”, at the Association of Community Cancer Centers 39th National Oncology Conference, which concluded in West Palm Beach, Florida.

His speech is part of the emerging consensus that improving patient experience and reducing cancer costs calls for prevention through healthier living or early detection of cancer when it is easier and cheaper to treat. . The second approach requires using data and risk stratification strategies to screen patients and rethink reimbursement, which should reward health systems based on a population health model, rather than just paying for tests. based on individual patient risk.

Koroscik began by explaining why population health in oncology “is all the rage.” Although Allina made her commitment before the pandemic, COVID-19 has highlighted the enormous need for a population health approach, and the “silver linings” of this experience are fueling some of the early stages of the process. ‘AHCI.

“Cancer care was disjointed,” Koroscik said. “Even the mapping of our largest type of cancer – breast cancer – had over 33 touchpoints” before the AHCI redesign began. Clearly, an intervention that renewed the traditional “star” relationship between flagship sites and rural sites needed to be rebuilt.

“We knew our value proposition was redefining cancer care, making it accessible,” he said. “We had to focus on a new network.”

In August 2020, Allina Health reached an agreement on what has been described as a “historic” value-based contract with Minnesota’s Blue Cross Blue Shield, and Koroscik said big payers are central to AHCI’s value-based care efforts.

From there, he said the AHCI model would be an accessible “seamless connections” model that recognizes the multiple factors – mind, body, and spirit – that affect overall health. He understands:

  • Integration of primary care and mental health
  • A financial navigation program for patients that tackles financial toxicity
  • Exceed expectations in testing and surveillance
  • Convenient hours and availability of emergency care, to reduce emergency room visits and hospital admissions
  • Better use of nurse navigators, “to thrive, not just to survive” under bundled payment arrangements
  • Initial engagement of payers in innovative population health initiatives, which include social and community initiatives.

Lessons from COVID-19. The sharp drop in cancer screening that took place in the early months of the pandemic – and the resulting cancers – argue for the focus on preventive care and meeting social needs. “The numbers were devastating,” Koroscik said.

But building a patient-centered, population-health-focused model of oncology “necessarily depends on finding a sustainable path,” Koroscik said, so cost control is part of the picture. . At the “macro level” this means building a model based on evidence-based care, minimizing variation in care, and paying attention to the total cost of care. Other interventions will focus on:

  • Reduce acute care crises
  • Fewer emergency room visits, hospital admissions and reduced length of stay
  • Improved care transitions and care management
  • Appropriate site of care, including home care, if appropriate

Typical features of value-based care agreements are referrals based on total cost of care, shared savings, and pay-for-performance. Adding population health to cancer care will put more emphasis on risk adjustment, Koroscik said. Palliative care will continue to attract attention, as will minimizing unnecessary variation in care.

To support these agreements, Allina Health will leverage IT support that goes beyond traditional avenues to more “real-time” assessment and better panel management. Koroscik reviewed the elements that go into a “composite risk score,” which is a measurement and decision-making tool that reflects the urgency of the patient’s situation, the magnitude of the clinical need, the financial risk, the social determinants of health and likelihood of adherence.

“For us, it’s really a game-changer,” he said. This is where Allina Health can change incentives for physicians to align with quality goals, reduce variation, and improve outcomes.

Current areas of focus are emergency department avoidance, clinical pathways – medical, radiological and surgical – management of changing symptoms near the infusion center, hospital at home program, breast cancer screening lung and encouraging conversations about serious illnesses. Looking ahead, Koroscik is aware of what is coming from CMS in alternative payment models (APM), including the long-delayed radiation oncology model that will likely reduce payments. Data collection is now essential to be ready when APM arrives, he said.

Allina Health is trying new things: 18,000 patients have been screened in a social vulnerability pilot project, and Koroscik said there are programs for LGBTQ populations and the Somali community in Minnesota.
In their work with payers, he said, it’s important to keep in mind that “packages may or may not be good,” depending on the population.

What is essential is the data. Even getting a basic metric like the number of patients accessed ED at 30 days isn’t always straightforward.

“Only 10 years ago I was out of data,” Koroscik said. “I don’t have too much data, but he’s getting the right data.”

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