The Centers for Medicare & Medicaid Services recently chose Atlantic’s six-hospital medical group and its Carol G. Simon Cancer Centers to participate with hundreds of others in testing an innovative new cancer care model. The feds hope this experiment, centered around better coordination, can lessen the swelling price tag for oncology, estimated to reach $158 billion by 2020. Participating docs will receive incentive payments for improving quality for chemotherapy patients, along with monthly payouts to help manage care for each beneficiary.
What interested Atlantic in trying out this model?
GRAGNOLATI: As we see opportunities to experiment in different models of care, we embrace them. At Atlantic, we have a strong oncology program. We access around 5,500 new patients annually, more than 20 percent of the cancer care cases diagnosed each year in northern New Jersey. That translates to about 90,000 patient visits within our practices, as well as our infusion and radiation treatment centers. We expect that to continue to grow not only because of the aging of the population, but also because we’re known in this market for providing outstanding cancer care, and that’s going to continue. We have the traditional kinds of services that you would expect of an organization of our size. We are working hard to integrate those services within our geographic footprint because we serve, just in our primary and secondary areas, more than 2 million people. We’ve worked hard to embed palliative care practitioners in our physician offices as well as our cancer centers, and that has really helped. We also employ about 60 oncology specialists, but we work closely with our self-employed or private practice physicians and we operate the cancer center with a focus on quality; we treat the whole patient and support our patients every step of the way.
Any patient stories you’ve heard that signal the importance of this endeavor?
GRAGNOLATI: In a recent series of health forums, we had an opportunity to hear in one of our patient’s voices how she received care at multiple sites within our system, how connected it was and how it drove a better outcome than she could have hoped for, in a caring manner. One of our challenges in cancer care is that because of the advances we're making in some forms of cancer, it’s moving more to a chronic disease state. We need to make sure that all the pieces are connected, the information moves with the patient, and that somebody is there to guide the patient through this overwhelming process. Treatments for a cancer diagnosis can last a number of years, so you need to develop services that are connected and facing the patient in a helpful way. So, at Atlantic, we stay focused on the whole patient, the family and how we work with those individuals. At the same time, we’re making some big investments in information technology to make sure care is connected, and we’re able to use more data to drive our decision-making. The patient I described was fighting a significant gynecological cancer. She felt she had a great experience because of our staff and not necessarily because of our systems. When we looked back at just the movement of information, she was on seven different medical records. Yet, because of the work of our staff, we were able to connect her care. Two years from now, if a patient comes through our system in the same manner, he or she will be on a unified health record that spans our entire system, and our staff will be able to do more for that patient than they ever were able to do.
Is it difficult for oncologists to think in a value-based mindset?
GRAGNOLATI: When you talk to front-line health care providers today, they are always trying to do the right thing for patients. Oftentimes, the right thing to do is flavored by the way the insurance and reimbursement systems work. You’ve heard about the concept of defensive medicine: If you don’t do everything for a patient, you’re putting yourself at risk for a lawsuit. Many factors go into participating in these kinds of efforts led by CMS. The way you need to connect care today may be at odds with some of the fraud and abuse regulations. At the same time, we’re changing the way we experiment with the payment system, we also have to make sure that the regulations keep up so that one hand is not innovating while the other is still stuck in an old model. We must begin to think more holistically about the entire patient experience — looking at care and payment longitudinally and investing in data and in navigators — which is different from what we do today. That’s going to allow us to drive down per capita spending while we improve quality. I think that you’re naturally going to see providers gravitate to a more patient-focused and commonsense approach to care, rather than one that’s constrained by the way we’re paid today. A lot of our systems of care in the U.S. have been designed because of the way we’re paid, and when you take some of those constraints away, you’re going to see more innovation.