By Steve Sinovic / Journal Staff Writer
ALBUQUERQUE, N.M. — Three New Mexico medical practices are among the 200 nationwide selected by the Centers for Medicare & Medicaid Services to participate in a care delivery model that encourages higher quality, more coordinated cancer care.
Indeed, one Albuquerque medical group’s treatment methods — New Mexico Hematology Consultants — will be incorporated in the initiative.
Seventeen health insurance companies, including Blue Cross Blue Shield of New Mexico, were also selected for the five-year pilot program, which will include more than 3,200 oncologists and cover about 155,000 beneficiaries nationwide. The number of New Mexicans that will be eligible for the program was not immediately available.
The physician groups in the state besides New Mexico Oncology Hematology Consultants are Lovelace Health System and Christus St. Vincent Regional Cancer Center in Santa Fe.
“The Oncology Care Model encourages greater collaboration, information sharing and care coordination, so patients get the care they need, when they need it,” said Health and Human Services Secretary Sylvia M. Burwell. “This patient-centered care model fits within the administration’s dual missions for delivery system reform and the White House Cancer Moonshot Task Force — to improve patient access to and the quality of health care while spending dollars more wisely.”
Medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion, an increase of 27 percent over 2010 based on growth and aging of the U.S. population, according to the National Institutes of Health. A significant proportion of those diagnosed are over 65 years old and Medicare beneficiaries. This year, more than 1.6 million new cases of cancer will be diagnosed, and cancer will kill about 600,000 Americans.
As the lead practice in the Centers for Medicare and Medicaid Innovation Award a few years ago, Hematology Consultants, led by CEO Dr. Barbara McAneny, pioneered the concept of an oncology medical home, working with six practices around the country to keep patients healthier, at home and out of the hospital — all at a lower cost than larger providers, said Nina Chavez, the practice’s chief operating officer.
The CMS Oncology Care Model is designed to encourage practices to improve care and lower costs through perforance-based payments that reward high-quality care. The practices will provide treatment following nationally recognized clinical guidelines for beneficiaries undergoing chemotherapy.
Enhanced services under the pilot program, according to CMS, may include coordinating appointments with providers within and outside the oncology practice to ensure timely diagnosis and treatment, providing 24/7 access to care and arranging for diagnostic scans and follow up with other members of the medical team such as surgeons, radiation oncologists and other specialists.
Blue Cross Blue Shield of New Mexico launched a pilot project a few months ago with New Mexico Hematology Consultants for a separate program to better serve some commercial group members, said John Cook, vice president of network services for the insurer. A small group of cancer patients will take part in the project over the course of 12 to 18 months.
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Albuquerque Journal
