Smart-Texting High-Risk Patients After Chemotherapy Reduces ED Visits

This is the third blog post in a 6-part series recognizing the achievements of the 2024 ACCC Innovator Award winners before their in-depth sessions at the ACCC 41st National Oncology Conference. You can learn more about the innovations being recognized this year and those who pioneered them by joining ACCC in Minneapolis, Minnesota, from October 9-11, 2024.

Quality measure OP-35—the first chemotherapy-specific measure in the Centers for Medicare & Medicaid Services (CMS) Hospital Outpatient Quality Reporting Program—went into effect for payment determination in 2020. In preparation, Mercy, Mercy Oncology Services, analyzed 240,000 of their qualifying chemotherapy visits that met the criteria for measure OP-35 and identified the clinical variables associated with patients’ increased risk of hospital admissions or emergency department visits. Based on that data, Mercy developed a predictive algorithm that identifies and manages chemotherapy patients who are at high risk.

The program received a 2020 Association of Cancer Care Centers (ACCC) Innovator Award for their initiative. And by improving that model to include smart texting, they earned a 2024 ACCC Innovator Award. With the ACCC 41^st National Oncology Conference on the horizon, ACCCBuzz spoke with Michelle Eichelmann, executive director, Mercy Oncology Services and Precision Medicine, and Jay Carlson, DO, medical director, Cancer and Research, Mercy Oncology Services, to learn more about their program.

ACCCBuzz: How long has Mercy, Mercy Oncology Services been an ACCC member?

Eichelmann: For a long time—42 years to be exact.

ACCCBuzz: What is your favorite part of being an ACCC member, on a personal level and within your program?

Dr. Carlson: Mercy is a huge system—spanning over 4 states—and we routinely hear from our communities about the different [educational] projects ACCC offers. We have regular oncology service line meetings, and anytime somebody has an idea or question, we often realize that ACCC has some useful information about it. This allows us to leverage the strategies and solutions that another hospital or system has developed.

Eichelmann: The daily bulletins [posts to ACCC’s online community ACCCeXchange] that come out are beneficial for us from an operational perspective. It is neat to listen to what others [ACCC members] are doing or other challenges they are encountering. I also love the fact that ACCC offers educational opportunities for us to attend. I think that helps us level set our teams when trying to move a project forward because we can look to other institutions who have had success with similar initiatives.

ACCCBuzz: What makes your cancer program unique?

Dr. Carlson: Mercy has 40 hospitals across the health system with 2.5 million unique patients. We have a huge primary care base that has several community hubs within that 4-state footprint. This allows us to have specialty care and we are all on one EHR [electronic health record], so when we develop our initiatives, everyone in the health system becomes aware of it. For this project, we can have everything linked. We are ahead on our data and analytics.

To expand on that, we have taken our data and developed an intelligence data platform that is cloud based. So, we can look at all our EHR data in a portal, write a query, and have immediate access to all the requisite data. When we won the ACCC Innovator award in 2020, we had to gather data in a clunky format, and it took months to get the data. With our current process, we had the data back in a day. We are a large system, but because of how we have leveraged data, we are very well positioned to answer [patient] questions quickly.

Eichelmann: We use our data in amazing ways to impact our outcomes. When we recognize areas of opportunity, Mercy is very quick to pivot and make changes. Another unique thing about our organization is that we are service line driven. We can roll out the same program across all our facilities, so everyone is doing the same thing regardless of where they are located.

Dr. Carlson: So, where as some health systems may have a president of a clinic, what we have is a president of Oncology, over the entire service line at all the hospitals, across all the states. This allows us to standardize processes and workflows under a single leadership structure. 

ACCCBuzz: Why was it important for your program to build on its 2020 ACCC Innovator Award?

Eichelmann: To have the information is one thing but to drive change is another. If you have data and you don’t act on it, there is no reason to have the data. So, we know we have a challenge with patients who have a high incidence of ED [emergency department] or inpatient visits and we know the risk factors that drive that, then we can proactively address those patients to reduce the ED or inpatient visits.

ACCCBuzz: ACCC president Nadine J. Barrett, PhD, MA, MS, centered her theme on Reimagining Community Engagement and Equity in Cancer. What does that look like to your program?

Eichelmann: Our system is very committed to caring for all patients regardless of their ability to pay. We have financial counselors who will work with patients to connect them with resources. Our navigation team identifies any barrier to care for our patients whether it is housing, transportation, or food insecurity. It is built in as part of our EOM [enhancing oncology model] flow sheet to make sure that we are asking patients those questions to ensure we don’t miss those barriers to care.

ACCCBuzz: What can attendees expect from your session at the ACCC 41st National Oncology Conference?

Eichelmann: We will work through how the model was developed, how we identify high-risk patients, how smart-texting was implemented, how we track patients, and the outcome impact we have had.

“Jiajing Chen, PhD, MPH, was the lead data scientist who conducted the original OP-53 study under an Institutional Review Board protocol. Dr. Chen extracted data from 2016 to 2018 and implemented the first machine learning model in SAS. The model discussed in this article is an update to her version. Dr. Chen was incredibly intelligent, persistent, and knowledgeable, and always kind and generous with co-workers. Our hearts broke when she lost her own battle with cancer in January of 2023.” ~Mercy Oncology