the COME HOME model

On July 1, 2012, Dr. Barbara McAneny and Innovative Oncology Business Solutions were awarded a $19.76 million grant from the Center for Medicare & Medicaid Innovation (CMS/CMMI) to develop a community oncology medical home model and implement that model in seven practices across the country. This award represented the culmination of several years of research and development on the part of Dr. McAneny and individuals at New Mexico Cancer Center as various concepts and strategies were considered, vetted, and eventually tested for viability at NMCC before inclusion in the proposal.

The Community Oncology Medical Home (COME HOME) grant builds on the concept of a patient-centered medical home by including seven important components: (1) an ongoing relationship with a personal physician to provide first contact, continuous and comprehensive care; (2) physician-directed team care; (3) whole person orientation; (4) integrated/coordinated care; (5) evidence-based medicine and performance measurement to assure quality and safety; (6) enhanced access; and (7) payment to recognize the value-added of a medical home.

The goal of COME HOME is to improve health outcomes, enhance patient care experiences and significantly reduce costs of care. We believe that this is possible by improving timeliness and coordination of care and by keeping patients out of the emergency department (ED) and hospital as much as possible. Our target population is newly diagnosed or relapsed Medicare, Medicaid and commercially insured patients seeking oncology care at one of 7 participating clinics. These patients require the wide range of coordinated care that COME HOME can deliver. We conservatively estimate that COME HOME will enroll approximately 8,022 Medicare and 1,530 non-Medicare (Medicaid, commercially insured) patients during the 3 year project.

COME HOME clinics will deliver all outpatient cancer care, including: triage pathways that ensure patients receive the right care in the right place at the right time for all aspects of cancer care, diagnostic pathways that address appropriate imaging, pathologic testing and molecular diagnostics, and therapeutic pathwaysdelineating chemotherapy, radiation oncology,  supportive care, and surgery (when applicable). The enhanced services offered under the COME HOME program include: patient education and medication management counseling, team care, 24/7 practice access (telephone triage, night/weekend clinic hours, and on-call oncologists), on-site or near-site imaging and laboratory testing, and admitting physicians who shepherd patients through inpatient encounters, avoiding handoffs and readmissions, to ensure seamless, safe and efficient care.

Seven community oncology practices are participating in the COME HOME program:

  • Austin Cancer Center
  • Ft Worth Centers for Cancer & Blood Disorders
  • Dayton Physicians Network
  • New England Cancer Specialists
  • New Mexico Cancer Center
  • NW Georgia Oncology Centers
  • Space Coast Cancer Center

Other key organizational partners include: IOBS (Innovative Oncology Business Solutions, Inc. the managing organization), Net.Orange (a software company for patient data integration and quality of care/pathway compliance tracking) and the University of Tennessee Health Science Center (for evaluation and cost analysis).

We project overall Medicare cost savings of $4,178 per member per year (PMPY), which represents a savings rate of approximately 6.276%. Based on a Medicare enrollment of 8,022 patients over 3 years, we project total Medicare savings of $33.5 million and net savings of $13.76 million (after budget costs).