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Drive value with these 3 oncology care models

April 4, 2017

    You probably know that end-of-life care is often expensive, fragmented, and wasteful. But do you know what to do about it? 

    A recent study published in Heath Affairs investigated three end-of-life oncology care models—the medical home, embedded patient navigation, and enhanced palliative care—and found that all three had success with managing costs and ensuring high quality care for terminal patients.

    Read on to learn more about these models and how they can drive value at your organization.

    1. Reduce avoidable hospitalizations with the medical home

    A medical home is a care delivery model that provides coordinated care and enhanced patient access through primary care provision. To fulfill these aims, providers may employ services such as a 24/7 triage phone line, same-day appointments, and extended hours. In the study, leaders established diagnosis and treatment pathways based on national evidence-based guidelines with the goal of reducing care variation. The medical home helped to reduce hospitalizations at the end of life. In fact, patients experienced 57 fewer hospitalizations per 1,000 patients in the last 30 days of life relative to a comparison population.

    Key Takeaway: To reduce unnecessary hospitalizations for patients at the end of life, make it easy for them to access physicians who are familiar with their medical history in an outpatient setting. Also, try utilizing evidence-based treatment pathways that are tailored to this complex patient population.

    2. Decrease end-of-life costs with patient navigation

    The patient navigation model employs non-clinical navigators to educate patients, connect them with resources, and improve adherence to care plans. In the study, navigators acted as liaisons between patients and health care providers to clarify treatment plans and voice patient concerns. Average spending in the last 90 days of life was $5,824 lower for patients in the patient navigation model than for patients in a comparison group. In addition, patients were more likely to be enrolled in hospice (an additional 85 patients per 1,000 relative to patients in the comparison group).

    Key Takeaway: To reduce end-of-life costs, match terminal patients with navigators who specialize in the needs of this population and can encourage them to access appropriate and beneficial care, including hospice services.

    3. Reduce futile end-of-life interventions with palliative care

    In the study, nurses administered patients a self-reported outcomes survey. The survey results were used to identify patients in most need of pain and symptom management, who were then referred for more intensive palliative care services. The palliative care model helped to reduce the use of chemotherapy in the last two weeks of life, which is generally considered to be of low clinical value for terminal cancer patients and is inconsistent with the goals of maximizing patient comfort and pain management.

    Key Takeaway: To reduce futile end-of-life interventions, develop a formal process for identifying patients who are most in need of pain and symptom management and for referring them to enhanced palliative care. 


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