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Three years ago, Allina Health, a nonprofit that operates 10 hospitals and more than 90 clinics in Minnesota and western Wisconsin, decided to invest in cancer care with a public health focus. Doing so will require Allina to “reimagine the patient experience” in cancer care, said Mike Koroszic, vice president of oncology, Allina Health Cancer Institute (AHCI).
On Friday, Koroscik provided an update on how that process has progressed to AHCI, which has begun October 2021. Koroscik presented ““Preparing for Public Health in Oncology.” In Proceedings of the Association of Community Cancer Centers 39th National Oncology Conference, West Palm Beach, Florida.
His speech calls for improving the patient experience and reducing cancer costs through prevention through healthy living or early prevention when it is easier and less expensive to treat cancer. A second approach calls for using data and risk stratification strategies to screen patients and rethink reimbursement, rewarding health systems based on a public health model rather than paying only for tests based on individual patient risk.
Koroskic began by discussing why oncology is “in vogue” in public health. Although Alina made the commitment before the outbreak, COVID-19 has highlighted a pressing need for a public health approach, and the “silver linings” of that experience are fueling some of AHCI’s first initiatives.
“Cancer treatment is fragmented,” Korasik said. Before the AHCI reform, it was “even targeting our largest cancer type – breast cancer – with more than 33 touch points”. It had to rebuild an intervention that renewed the traditional “communication and dialogue” relationship between the flag and the rural areas.
“We know our value proposition will redefine cancer care and make it accessible,” he said. “We had to focus on a new network.”
In August 2020, Alina Health They have reached an agreement In what has been described as a “landmark” value-based contract with Minnesota Blue Cross Blue Shield, and Koroscik said large payers are focused on AHCI value-based care.
From this, he said, the AHCI model will be one of “seamless connections” that recognizes the many factors that influence overall health: mind, body and spirit. Includes:
- Integration of primary care and mental health
- A patient financial exploration program that solves financial toxicity
- More than expected on inspection and monitoring
- Convenient hours and availability of urgent care to reduce emergency department (ED) visits and hospital admissions
- Better use by nurse sailors, “not just to survive” with lump sum payment arrangements
- Early involvement of payers in new public health initiatives involving social and community-based initiatives.
Lessons from Covid-19. The sharp decline in cancer diagnoses in the first months of the epidemic—and subsequent cancers—build the case for a focus on preventive care and social needs. “The numbers were horrendous,” Koraszic said.
But building a patient-centered, public health-focused oncology model is necessarily “based on finding a sustainable path forward,” Koroscik said, so cost control is part of the picture. By “macro level” we mean building an evidence-based model of care, reducing disparities in care and paying attention to the total cost of care. Other interventions focus on:
- Reducing emergency care crises
- Fewer ED visits, hospital admissions and length of stay
- Improved care transition and care management
- Appropriate place of care including home care
Common features of value-based care agreements are benchmarks based on total cost of care, shared savings, and performance pay. Adding public health to oncology care puts more emphasis on risk adjustment, Koraszic said. Palliative care will continue to receive attention, as well as reduce unnecessary variation in care.
To support these agreements, Allina Health relies on data support that goes beyond traditional means to “real-time” assessment and better panel management. Koroscik reviewed the elements that go into the “composite risk score,” a scale and decision tool that reflects the urgency of the patient’s condition, depth of clinical need, financial risk, health social factors, and likelihood of adherence.
“For us, this is a real game changer,” he said. This is where Allina Health changes incentives for physicians to align with quality targets, reduce disparities and improve outcomes.
Current areas of focus are AD avoidance, clinical pathways—medical, radiation, and surgery—transitional symptom management near the vaccination center, home hospital program, lung cancer screening, and promoting chronic illness discussions. Looking ahead, Koroscik notes what’s coming from CMS through alternative payment models (APMS), including the long-delayed radiation oncology model that will reduce payments. It is important to gather information now to be ready when APM comes, he said.
Allina Health is trying new things: 18,000 patients have been screened as part of a social vulnerability pilot, and Koroscik says there are programs for the LGBTQ population and Minnesota’s Somali community.
In working with payers, it is important to consider that “a package may or may not be good” depending on the population, he said.
The key is data. Even getting a basic measure of how many patients experience ED in a 30-day period is not always easy.
“Just 10 years ago, I was starved for information,” Koroskic said. “I don’t have a lot of data, but it’s getting the right data.”
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