Practice Transformation (PT) in healthcare refers to a systematic process of change within the operations of a medical institution. It is an evidence-based framework, defined by the Centers for Medicare & Medicaid (CMS) as “observable and measurable changes to practice behavior.”
The end goals of practice transformation are improved healthcare outcomes, better relationships between patients and providers, and preventative care based on the centering of the patient’s experience. It also involves an overhaul of the business and financial side of healthcare provision, implementing efficiency measures to eliminate waste, save costs, and intelligently allocate resources. This healthcare methodology is intended to get better healthcare results for every resource spent and is often called value-based, or precision care.
Practice Transformation in Oncology
The drive toward value-based care has been a priority in the oncology sector for some years, thanks to initiatives and standards set by the federal government. In 2023, the established Oncology Care Model (OCM) of practice transformation is set to transition to Enhancing Oncology Model (EOM). Set to launch on July 1, 2023, this model focuses on patient-centered care, health equity, and financial efficiency while incorporating what was learned during OCM.
Four Steps for Successful Practice Transformation
- Identify High-Risk Populations
Preventative healthcare measures not only result in an improved quality-of-life for patients but also reduce costs for the provider by preventing expensive acute and emergency inpatient treatments. High-performing organizations adopted solutions to effectively manage hospital admissions, emergency department (ED) admissions, end-of-life expenses, and treatment decisions. These actions were made possible by identifying and targeting high-risk populations via electronic data collection and analytics. - Implement Analytics
One source of insights on best practices would be claims data from MEOS (monthly enhanced oncology services) payments granted to organizations working under the OCM model. However, relying on claims data alone is not enough, because the limited information and lag time is difficult to translate into practice for a specific organization. Instead, clinical data-enabled analytics are needed for actionable insights to drive success—an organization should work with knowledge of the patient population in its area as well as the medical and cost-effectiveness of its processes. - Understand the Value of Care Coordination Services
Care coordination is a core element of practice transformation which involves centering the patient’s experience and sharing information among all stakeholders, including family, caregivers, and medical staff. This is key for building trust, engagement, and strong relationships in the healthcare home, a crucial aspect of value-based care. IT tools such as cloud data systems, apps, and patient portals all facilitate care coordination. - Invest in IT Infrastructure
As the oncology sector prepares to adopt EOM, it is recommended that organizations invest in practice transformation infrastructure , including software tools, that will enable them to integrate data collection and real-time analytics to optimize efficiency and performance. These include electronic health record (EHR) management, communication systems, risk population assessment, and financial planning tools.
Developing such tools requires considerable research and expertise, but organizations that either require PT features built from the ground up or need to integrate additional technology to support PT in their EHR infrastructure can contract an experienced agency that specializes in tools to support oncology.
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Sources:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo
https://www.healthcatalyst.com/insights/4-population-health-strategies-drive-improvement
https://www.cms.gov/newsroom/fact-sheets/enhancing-oncology-model
https://nachc.org/wp-content/uploads/2019/03/Risk-Stratification-Action-Guide-Mar-2019.pdf
https://www.ahrq.gov/ncepcr/care/coordination.html
