HARTFORD, Conn. – Aetna (NYSE: ΑET) and Consultants 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™) 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™ 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).