Reducing Cancer Costs Through Symptom Management and Triage Pathways. 2019

Ronald Barkley, and Mah-Jabeen Soobader, and Jun Wang, and Sibel Blau, and Ray D Page
1 Cancer Center Business Development Group, Lighthouse Point, FL.

Value-based care infers care that is high quality at a comparatively low total cost. A key strategy for value-based oncology care is to avoid unnecessary emergency room (ER) visits and associated hospitalizations of patients receiving treatment for cancer. Early experience with this strategy showed that symptom management in patients with cancer can result in the reduction of ER events and hospitalizations. However, quantifying the actual savings achieved has been elusive. In this article, we present the impact of symptom management and triage pathways programs deployed at two midsize community oncology practices. We then quantify the actual dollar saving in their Medicare and commercial populations. Symptom management records generated through the ER triage programs at the two practices were screened to identify avoided ER events. This approach was validated with an independent analysis using Medicare claim data from the Oncology Care Model program in which both practices participate. Bootstrap simulations were used to test for statistical significance of the ER event rate changes before and after the launch of the program. Average event and annual total cost savings from avoided ER incidents and ER-related hospitalizations were then calculated. Two hundred twenty-two avoided ER events were identified, for an estimated net annualized savings generated by the two practices of $3.85 million. Although the ER rate reduction was not statistically significant, these findings are consistent with the observed reduction of ER event rates among a subset of Oncology Care Model beneficiaries at the two practices. ER events and associated hospitalizations can be avoided as well as quantified as a result of the deployment of a practice-level integrated platform that incorporates physician-scripted symptom management protocols and telephone triage pathways.

UI MeSH Term Description Entries
D008297 Male Males
D008495 Medical Oncology A subspecialty of internal medicine concerned with the study of neoplasms. Oncology, Medical,Clinical Oncology,Oncology, Clinical
D009369 Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Neoplasm,Cancer,Malignant Neoplasm,Tumor,Tumors,Benign Neoplasms,Malignancy,Malignant Neoplasms,Neoplasia,Neoplasm,Neoplasms, Benign,Cancers,Malignancies,Neoplasias,Neoplasm, Benign,Neoplasm, Malignant,Neoplasms, Malignant
D010166 Palliative Care Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Palliative Treatment,Palliative Supportive Care,Palliative Surgery,Palliative Therapy,Surgery, Palliative,Therapy, Palliative,Care, Palliative,Palliative Treatments,Supportive Care, Palliative,Treatment, Palliative,Treatments, Palliative
D004632 Emergency Medical Services Services specifically designed, staffed, and equipped for the emergency care of patients. Emergency Care,Emergency Health Services,Emergicenters,Prehospital Emergency Care,Emergency Care, Prehospital,Emergency Services, Medical,Medical Services, Emergency,Services, Emergency Medical,Emergency Health Service,Emergency Medical Service,Emergency Service, Medical,Emergicenter,Health Service, Emergency,Health Services, Emergency,Medical Emergency Service,Medical Emergency Services,Medical Service, Emergency,Service, Emergency Health,Service, Emergency Medical,Service, Medical Emergency,Services, Emergency Health,Services, Medical Emergency
D005260 Female Females
D006760 Hospitalization The confinement of a patient in a hospital. Hospitalizations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013781 Texas State bounded on the north by Oklahoma, on the east by Arkansas and Louisiana, on the south by Mexico, and on the west by New Mexico.
D014218 Triage The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. Triages

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