in Medical Oncology and Hematology, PC (CMOH) have launched a
first-of-its-kind patient-centered medical home model for oncology.
Combining the proven
results of evidence-based decision support in cancer care, enhanced
personalized services, and realigned payment structure, Aetna and CMOH
are collaborating to help increase treatment coordination, improve
quality outcomes and reduce costs.
More than half of all new cancer patients are 65 or older, and most have
one or more health condition in addition to cancer. Proactive outreach
and engagement are the first lines of defense in avoiding complications
of cancer treatment as well as other chronic diseases.
"Given the frequency of contact, oncologists are in a prime position to
help their patients navigate the health care system to get appropriate
and aligned treatment for all of their conditions. Helping a patient
coordinate care for an underlying heart condition while being treated
for prostate cancer is the right thing to do," says Michael Kolodziej,
M.D., FACP, Aetna national medical director for Oncology Strategies.
Aetna delivers enhanced technology and financial solutions
Aetna helped CMOH, located in Southeast Pennsylvania, build on their
success in personalized care by coordinating access to
eviti's evidence-based decision support tool. The tool helps to
reduce variability in cancer care by speeding the identification and use
of evidence-based, clinical best practices. The tool's treatment options
facilitate coverage under a patient's benefit plan and are available in
real time. Oncologists who use eviti also benefit from a streamlined,
automated preauthorization process. The Aetna
Innovation Labs first made eviti available last year through iNexx®,
a data exchange and applications platform.
Combining the best of two models
Recognizing their important role in coordinating care, CMOH became the
first oncology practice to be recognized by the National Committee for
Quality Assurance (NCQA) as a Physician
Practice Connections®-- Patient-Centered Medical Home (PPC-PCMH TM) in
2010. To recognize the combination of personalized care and clinical
decision support, Aetna combined key financial arrangements of PCMH and
oncology programs. CMOH will receive financial recognition for expanded
services provided to commercial (non-Medicare) Aetna members.
"The OPCMH model supports clinical decision making at each patient
interaction, merges care processes, workflow, documentation and
communication. The model is based on continuous improvement, resulting
in better care delivery, better patient health, and lower costs. Our
drive to enhance the value of cancer care is shared by Aetna, and we are
excited to begin to see realigned payment structures that recognize the
benefits of this model," says John D. Sprandio, MD, FACP,
physician-in-chief at CMOH.
Aetna is one of the nation's leading diversified health care benefits
companies, serving an estimated 44 million people with information and
resources to help them make better informed decisions about their health
care. Aetna offers a broad range of traditional, voluntary and
consumer-directed health insurance products and related services,
including medical, pharmacy, dental, behavioral health, group life and
disability plans, and medical management capabilities, Medicaid health
care management services, workers' compensation administrative services
and health information technology products and services. Aetna's
customers include employer groups, individuals, college students,
part-time and hourly workers, health plans, health care providers,
governmental units, government-sponsored plans, labor groups and
expatriates. For more information, see www.aetna.com.
CMOH is an independent oncology and hematology practice in southeastern
Pennsylvania. CMOH is the first hematology/oncology practice to obtain
the National Committee on Quality Assurance's (NCQA) Level 3 PPC-PCMH TM
recognition and the first practice in Southeastern Pennsylvania to
receive the Quality Oncology Practice Initiative (QOPI) certification
from the American Society of Clinical Oncologists (ASCO).
Tammy Arnold, 713-721-7891