Next Steps in Oncology Payment Reform for Established Provider & Payer Teams Presented By: Robert Baird CEO, Dayton Physicians Network Community Oncology.

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Presentation transcript:

Next Steps in Oncology Payment Reform for Established Provider & Payer Teams Presented By: Robert Baird CEO, Dayton Physicians Network Community Oncology Alliance Conference April 23, 2015

Multi-Specialty Group Practice 15 Practice Locations: o 4 Urology offices o 1 Radiation Oncology office o 2 Medical Oncology Offices o 1 Pathology Office o 1 Business Office o 6 Comprehensive Cancer Centers 43 Physicians and Mid Level Providers 317 Employees 40,508 Individual Patients 231,412 Patient Visits 538,084 Phone Calls Hem/Onc Radiation Urology Imaging Pathology Dayton Physicians Network

Focus On Quality and Innovation o CMMI Grant Funded Oncology Medical Home Practice o United Health Care, Episode Fee Payment Program Participant o Anthem Quality Care Program Participant o Aetna OMH Pilot Program Participant o National Radiation Oncology Registry Program Participant o CMMI Oncology Care Model (LOI submitted)

Payment Reform (Payer attributes) o Rewards / supports value (high quality, lower cost) Pathways / Evidenced base care Appropriate case setting o Expedited Pre cert / Pre authorization process Operational efficiency o Transparency / sharing of data

Collaborative Relationships o Increased market share o Maximize patient experience o Reduce out migration

Medicare Data July 2011 – July 2012 Dayton Physicians Network Cancer Care o 37% Fewer In-patient Visits o 48% Shorter LOS o 24% Fewer ED Visits o 16% Reduction in Total Costs

56% *Number of chemo pts visiting ED $800 *Average cost of cancer- related ED visit 63% *Number of ED visits resulting in admission $22,000 *Average cost of cancer- related admission Opportunities in Cancer Care *The Advisory Board Company – Urgent Care for Cancer Patients in 2013

Future o Getting focus off (for physicians) the drugs and decrease reimbursements (not the answer) o Attempts to link value and reimbursement o Risk = skin in game o Patients already have skin in game with increase in deductions / co-pays and in future, decrease in employee spend but defined contributions. o Best value for money spent