ASCO and the Community Oncology Alliance (COA) have published standards for the oncology medical home (OMH), a comprehensive system of care delivery that supports coordinated, efficient, accessible, and evidence-based care.1 The standards serve as a roadmap for practice transformation—systematically supporting high-quality care and models of value-based reimbursement.
Kim Woofter, RN
“It is imperative that practices implement a care delivery system that prepares them for the future of value-based care,” said Kim Woofter, RN, of Michiana Hematology Oncology’s Advanced Centers for Cancer Care, and Co-Chair of the expert panel that developed the new OMH standards.
Coordinating Care for Better Patient Experiences
The medical home concept, also known as the patient-centered medical home (PCMH), was first developed several decades ago to improve care coordination in pediatrics. The paradigm broadened to primary care, with its underlying need for patients to have a single care coordinating touchstone in the PCMH. Medical neighborhoods further extended the PCMH to specialty/subspecialty practices, recognizing that effective care coordination required communities of like-minded practices. These models were expected to deliver the triple aim: better quality of care, better patient experience, and decreased cost.
Over the past 20 years, pioneering oncologists have adapted these principles to oncology care delivery. One federally funded project demonstrated the feasibility of implementing the practice transformation processes, and another noted improvement in care quality and cost of care. These efforts informed the development of Center of Medicare & Medicaid Innovation Oncology Care Model. Many commercial payers have incorporated parts of OMH into value-based alternative payment models.
An ASCO and COA expert panel was charged with using ASCO’s clinical guideline development process to review and systematically evaluate the evidence supporting comprehensive OMH interventions.
The panel noted limitations of the evidence base, including a small number of studies and lack of data on longer-term outcomes.
Due to high resource requirements and questions regarding their value, literature on clinical pathways and survivorship care plans were reviewed. The panel found that the literature supported the use of clinical pathways to document evidence-based treatment and as a measurement tool to provide feedback for improvement. It also supported the requirement for a system of survivorship care, though not mandating specific care plans.
OMH challenges practices to systematize all aspects of care. It is the practice’s responsibility to engage patients and ensure they are knowledgeable about their condition, treatment goals, and expectations of therapy.— John Cox, DO, MBA, FASCO, MACP
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“The ASCO/COA OMH standards represent a comprehensive system of care,” said John Cox, DO, MBA, FASCO, MACP, of UT Southwestern Medical Center and Parkland Health System and Co-Chair of the expert panel. “From a patient’s view, oncology care cannot be ‘parsed’—it is all or none. OMH challenges practices to systematize all aspects of care. It is the practice’s responsibility to engage patients and ensure they are knowledgeable about their condition, treatment goals, and expectations of therapy.”
The new standards address patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety.
For example, standards for availability and access to care state that practices are to routinely provide patients with a best estimate of out-of-pocket expenses for any new therapy that is offered as well as financial counseling services, including assistance programs. Standards relating to goals of care require practices to routinely offer an advance care planning discussion with patients and must complete a goals-of-care discussion with all patients. The discussion must recognize the individual patient’s needs and preferences.
Dr. Cox said it is the duty of the practice “to ensure you are providing evidence-based therapies and be able to prove you are doing so.” He noted that the practice must work as a team to coordinate care for the patient, anticipate care needs, and be able to guide the patient to appropriate palliative care resources and provide end-of-life care discussions.
Focusing on Health Equity to Ensure Quality Care for All Patients
Health equity is also a major component of the OMH standards, which note: “Within each domain of these standards, practices should be guided by the ASCO policy statement on cancer disparities2 and endeavor to: (1) ensure equitable access to high-quality care; (2) ensure equitable research; (3) address structural barriers; and (4) increase awareness and action.”
“The most important benefit of the OMH standards is the value they represent for our patients,” Ms. Woofter said. “[They are a] standardized, evidence-based, care delivery system focused on high-quality, cost-effective care.”
Recognizing there is much to learn about care delivery, the expert panel views the OMH standards as an important but incremental effort that will no doubt be honed and improved with experience.
“Hopefully, practices will publish their experience with OMH to deepen the evidence base,” Dr. Cox said.
1. Woofter K, Adelson K, Bowman R, et al: Oncology medical homes: ASCO and COA Standards. J Clin Oncol. July 13, 2021 (early release online).
2. Patel MI, Lopez AM, Blackstock W, et al: Cancer disparities and health equity: A policy statement from the American Society of Clinical Oncology. J Clin Oncol 38:3439-3448, 2020.
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, July 14, 2021. All rights reserved.