Grow Locally, Deliver Care Regionally?

In response to the tsunami of change, innovation, and uncertainty underway across our healthcare system, new business models, relationships, and technologies in cancer care delivery are emerging.

At the ACCC 44th Annual Meeting & Cancer Center Business Summit, March 14-16, thought leaders and stakeholders in oncology with expertise in business, quality, technology, and policy will come together to explore trends, strategies, and provocative questions about the best way forward. As an example: Is regional cancer care delivery the next step in cost effective, coordinated care?

Read on for perspectives from Mathew Sturm, associate principal, ECG Management Consultants, and Kathleen LaRaia, executive director, Cancer Services, Munson Healthcare. Attend their session on “Organizing & Optimizing a Regional Cancer Delivery System” on March 15, and join the conversation. Panel moderator Michael L. Blau, Esq., Foley & Lardner LLP, will share an overview of other structural options for regional cancer care collaboratives, including joint ventures and the “hospital within a hospital model.”

Increasingly, health systems are thinking about cancer care delivery on a regional basis. Why? In many cases, this is both a response to environmental pressures and an effort to align cancer services with an organization’s regional care delivery strategy. Today’s patients and providers demand access to comprehensive, coordinated cancer delivery systems with leading technologies and clinicians. Given the cost and complexity of assembling these resources, it is important to design services lines efficiently to treat patients across the health system’s service area. Most systems identify some combination of the following goals for a regional cancer delivery system:

• Eliminate redundancies
• Reduce costs
• Optimize resources
• Improve outcomes
• Standardize care delivery
• Streamline program leadership
• Improve care coordination
• Improve access to care
  

As health systems contemplate a regional cancer delivery system, it is important to examine the delivery system across four dimensions:

• Programs. The various clinical, research, and support services provided to patients, representing the continuum of care.
• Physicians. Both the physicians’ clinical capabilities and degree of alignment with the delivery system.
• Facilities and Technology. The capital assets necessary to offer comprehensive cancer care to patients
• Business Structure. Governance and leadership framework utilized to oversee the program.

Commonly, a regional delivery system will be organized into one of three models:

• Hub and Spoke. A strong centralized site, often a cancer center, that houses much of the programmatic assets and expertise. Spokes, often freestanding medical oncology offices, are placed in the community to improve access to certain services.
• Distributed Model. The cancer delivery system is spread across multiple locations, but in discreet units. For instance, each center might focus on two or three tumor sites for which it offers specialized resources.
• Coordinated Model. Program distribution may be in part by clinical program (as in a distributed model) and in part based on Programmatic components (certain support services, key technology assets, etc.).

“Selecting a service distribution model that meets the needs of the community and capabilities of the health system is a critical first step in developing a regional delivery system. Once the preferred model has been selected, the system will need to determine an optimal deployment of programs and technology across the network,” shares Matthew Sturm, associate principal, ECG Management Consultants. “An inclusive governance structure that incorporates representation from key clinical and geographic constituents will also need to be developed.”

Kathleen LaRaia, executive director, Cancer Services, Munson Healthcare, offers another solution for aligning physician and administration partners: a management services agreement (MSA). A contract between a physician practice and a hospital, the MSA clearly defines expectations and objectives for the oncology service line, with physician compensation directly linked to those expectations and objectives.

“The MSA framework encourages senior and junior physician involvement. Physicians work alongside the management team to improve quality, efficiency, and effectiveness and, therefore, are actively involved in the daily operations,” says LaRaia. “An MSA can help ensure active work-group participation.”

LaRaia has this to say about her cancer program’s experience. “Our first year yielded active physician engagement, improved throughput and patient satisfaction, and a full payout of the at-risk performance measures that was shared with all employees.”
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Take part in critical conversations around the profound transformation underway in healthcare delivery and reimbursement at the ACCC 44th Annual Meeting & Cancer Center Business Summit. Explore the full agenda and register today!