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Priority Health: Oncology Medical Home Puts Patient Outcomes First

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X-Ray of lung cancer.

X-Ray of lung cancer.

GRAND RAPIDS — In keeping with society’s urgent need for more efficient and effective health care, Priority Health and Cancer and Hematology Centers of West Michigan have joined forces to explore an innovative oncology patient-centered medical home.

The medical-home model strives to integrate and coordinate the many office visits, medical professionals, high-tech services and care decisions encountered by cancer patients to help streamline their care while ensuring better outcomes.

“This project is a natural evolution of our extensive experience with medical homes,” said John Fox, M.D., associate vice president of medical affairs. “Cancer patients experience complex medical needs and rely on an extensive network of interdisciplinary health care specialists. Having a medical home can ensure cancer patients receive optimal care.”

“This will build upon our 30-year history of care delivery throughout western Michigan,” said Mark Campbell, M.D., president of CHCWM. “We believe through closer communications with the many stakeholders, we can help many patients work through the often intimidating maze of cancer care events.”

Through the agreement announced last week, Priority Health and CHCWM will work together to optimize the cancer patient’s health, ensure the best patient experience and eliminate avoidable costs. To achieve these goals, both organizations have agreed to payment reforms and care enhancements. Under this new model, oncologists will be paid a care management fee and will share in savings resulting from reductions in emergency visits, imaging and hospitalizations. Current fee structures pay physicians based on the costs of drugs administered, which results in higher payments for more costly drugs, not necessarily the physician’s time, expertise or resource utilization.

The care management fee will go directly for patient support services, such as end-of-life and financial counseling, case management, medication therapy management, survivorship programs and social work services.

“These reforms are consistent with best practices throughout health care,” said Fox. “As an industry, we are moving away from fee-for-service payment, which rewards volume, and instead are moving toward the use of preferred care protocols, advanced care planning and survivorship planning.”

“The new models put the focus squarely on the patient,” said Campbell. “We believe that this reflects the future for health care, and we want to be a leader in this effort.”

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