Next Steps in Oncology Payment Reform for Established Provider & Payer Teams Presented By: Robert...
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Next Steps in Oncology Payment Reform for Established Provider & Payer Teams Presented By: Robert Baird CEO, Dayton Physicians Network Community Oncology Alliance Conference April 23, 2015
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Transcript of Next Steps in Oncology Payment Reform for Established Provider & Payer Teams Presented By: Robert...
Next Steps in Oncology Payment Reform for Established Provider & Payer Teams
Presented By: Robert Baird CEO, Dayton Physicians Network
Community Oncology Alliance ConferenceApril 23, 2015
• Multi-Specialty Group Practice
2014 COMPANY PROFILE
• 15 Practice Locations: o 4 Urology offices o 1 Radiation Oncology office o 2 Medical Oncology Offices o 1 Pathology Officeo 1 Business Office o 6 Comprehensive Cancer
Centers
• 43 Physicians and Mid Level Providers
• 317 Employees
• 40,508 Individual Patients
• 231,412 Patient Visits
• 538,084 Phone Calls
Hem/Onc
Radiation
UrologyImaging
Pathology
Dayton PhysiciansNetwork
Focus On Quality and Innovation
o CMMI Grant Funded Oncology Medical Home Practice
o United Health Care, Episode Fee Payment Program Participant
o Anthem Quality Care Program Participant
o Aetna OMH Pilot Program Participant
o National Radiation Oncology Registry Program Participant
o CMMI Oncology Care Model (LOI submitted)
Payment Reform (Payer attributes)
o Rewards / supports value (high quality, lower cost)• Pathways / Evidenced base care• Appropriate case setting
o Expedited Pre cert / Pre authorization process• Operational efficiency
o Transparency / sharing of data
Collaborative Relationships
o Increased market share
o Maximize patient experience
o Reduce out migration
Medicare Data July 2011 – July 2012Dayton Physicians Network Cancer Care
o 37% Fewer In-patient Visits
o 48% Shorter LOS
o 24% Fewer ED Visits
o 16% Reduction in Total Costs
56%
*Number of chemo pts visiting ED
$800
*Average cost of cancer-
related ED visit
63%*Number
of ED visits
resulting in
admission
$22,000*Average cost of cancer-related
admission
Opportunities in Cancer Care
*The Advisory Board Company – 27863 Urgent Care for Cancer Patients in 2013
Future
o Getting focus off (for physicians) the drugs and decrease reimbursements (not the answer)
o Attempts to link value and reimbursement
o Risk = skin in game
o Patients already have skin in game with increase in deductions / co-pays and in future, decrease in employee spend but defined contributions.
o Best value for money spent
