OREANDA-NEWS. Blue Cross and Blue Shield of Illinois (BCBSIL) and Illinois Cancer Specialists (ICS), a practice in The US Oncology Network, announce the first oncology intensive medical home (IMH) pilot program in Illinois. The overall goal of the oncology IMH is to provide coordinated, cost-effective care, in part, through the use of evidence-based medical treatment guidelines.

“We worked with ICS physicians to develop the Oncology IMH model as a patient-focused system of delivering benefits for quality cancer care that is coordinated and efficient,” said Walter Hollinger, M.D., medical director of strategic operations at Blue Cross and Blue Shield of Illinois. “As such, the pilot program is designed to help meet the needs of patients, payers, and providers.”

Last November, the program started identifying BCBSIL PPO patients who were currently being treated by an ICS physician. To qualify, patients must be receiving chemotherapy or hormone therapy, with a cancer diagnosis of breast, colon, lung, pancreatic, prostate and any non-Hodgkin’s lymphoma. The program intends to enroll 150-200 patients per year. Current ICS patients are selected to join the program for six months while receiving treatment at one of the ten ICS sites: Arlington Heights, Bolingbrook, Chicago/Resurrection Hospital, Elgin, Hinsdale, Hoffman Estates, Huntley, McHenry, Niles and Woodstock.

“We at Illinois Cancer Specialists sought to improve efficiency and quality by following NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), leading to the development of a patient-centered, value-based cancer care program,” said David Hakimian, M.D., practice president, ICS. “Our goal is to provide evidence-based validated, outcome-driven patient care. This type of quality care also has to meet the national quality standards that follow cost-effective pathways to provide access and affordability to patients.”

Illinois Cancer Specialists provides Chicago area patients with advanced, comprehensive, compassionate cancer care in a community setting. The practice employs the latest technologies and drug therapies to ensure patients receive high-quality care for their particular diagnosis in a collaborative setting. ICS treatment centers feature outpatient treatment including chemotherapy, radiation therapy, positron emission tomography (PET), computerized tomography (CT), stem cell transplant, laboratory, x-ray studies, specialized pharmaceuticals, and clinical research, including immuno-oncology trials. A study published in the American Journal of Managed Care in 2015 titled, “Cost Differential by Site of Service for Cancer Patients Receiving Chemotherapy,” has shown that providing chemotherapy in a community setting rather than a hospital setting allows patients to stay near loved ones while receiving high-quality care at a lower cost.

Through the new IMH pilot, enrolled patients being treated at ICS will receive the free services of an ICS Nurse Care Manager (NCM), an oncology certified nurse whose primary purpose is to proactively address the challenging needs of oncology patients. The NCM will provide disease and treatment education, schedule phone calls after treatment, and closely follow symptom management issues. Subsequent meetings may include continued use of chemotherapy, advance care planning and hospice when appropriate. The ICS physicians will continue to assess these patients to develop and implement a plan of care that will attempt to actively address the patients’ needs during their treatments and beyond.

Some of the key aspects of the BCBSIL/ICS Oncology IMH model are:

  • Access to cancer care that is coordinated with the central focus on patients and their entire medical condition;
  • Cancer care that is optimized based on evidence-based medicine to produce quality outcomes;
  • Cancer care that is efficient, with treatment provided in a high-quality, low-cost setting for the patient;
  • Cancer care that is delivered in a patient-centric, caring environment that optimizes patient satisfaction; and
  • Cancer care that is continuously improved by measuring and benchmarking results against other facilities providing care, so that best practices “raise the bar” in delivering care.

“Providers with Illinois Cancer Specialists will enhance the quality of cancer care while controlling overall costs of care,” said Dr. Hakimian. “This will happen in a system where quality and value are measured and continuously improved.”

BCBSIL and ICS physicians will meet quarterly to exchange information and discuss if the IMH is a sustainable model for benefit and care delivery services. Some of the information discussed will include metrics on hospital admission rates, hospital days, ER visits, office visits and home health visits.

“The key to managing health costs is providing access to the right care in the right place,” said Dr. Hakimian. “This program with BCBSIL gives us valuable data that providers can use to improve the care our patients receive. This is a real opportunity for direct access to quality and cost data that will help inform decisions about how best to care for our patients. Blue Cross is making this level of transparency possible, something that wouldn’t otherwise be available to us.”

In traditional fee-for-service arrangements, reimbursement is based on specific services provided to patients; effectively rewarding providers for the volume of services they provide. In value-based care, provider reimbursement is associated with meeting quality or performance measures.

“Cancer care has evolved dramatically over the past 40 years from academic, in-patient treatment to community-based, comprehensive, and coordinated cancer care,” said Hollinger. “In this model, reimbursement to providers is more appropriately aligned with the quality and value of cancer care delivered.”

The IMH is one of BCBSIL’s value-based programs that utilizes incentives to engage healthcare professionals and help facilitate improved health, affordability and customer experience. The BCBSIL intensive medical home programs initially focused on large primary care physician groups and have expanded to include hospitals, small primary care practices and specialists. The first BCBSIL specialty intensive medical home was launched in 2014 with the Illinois Gastroenterology Group.

About Blue Cross and Blue Shield of Illinois

With over 8.1 million members, BCBSIL, a division of Health Care Service Corporation, a Mutual Legal Reserve Company, is the largest health insurance company in Illinois. Begun in 1936, BCBSIL remains member owned rather than publicly traded and is committed to promoting the health and wellness of its members and its communities, fostering greater access to care, and working to lower the overall cost of care while improving health care quality and patient outcomes.

About Illinois Cancer Specialists

Illinois Cancer Specialists (ICS) is dedicated to providing convenient, compassionate leading-edge cancer care to patients in Chicago and the surrounding areas. With more than 30 years in practice and over 400 years of combined physician experience, ICS is changing the forefront of patient care. Our dedicated and highly-skilled physicians and staff, who specialize in caring for patients with cancer and blood disorders, provide unparalleled access to the most innovative, advanced therapies and latest technologies throughout Chicago and the surrounding areas. With more than 20 board certified physicians, ICS offers convenient, compassionate care in ten locations.