A Place Patients with Cancer Can Call Home, Part 1: Page 2 of 2
FRMC: So it sounds as though you did not originally intend to qualify for PCMH status.
That’s right. When we started applying Gosfield and Reinertsen’s principles of transformation, the primary care PCMH standards were not even published yet. We were not intending to qualify for anything. We were inwardly focused on fixing the physician work environment, making care more effective, and developing systems that would help us become more accountable for quality and cost.
As we were doing this, unbeknownst to us, the primary care PCMH principles were developed in 2008. Once we became aware of the standards, we realized that we exceeded them. This sends a very powerful message.
FRMC: And what is that message?
The message is that the real barrier to improving the consistency, quality, and cost of care resides in fixing the physician work environment. We proved this by addressing the “physician time-stealers” when we created an oncology-specific process, work flows, and supportive technology. We focused on addressing the day-to-day misery that we faced as physicians, and we ended up positively driving the consistency, quality, and cost of cancer care—and qualifying for NCQA recognition. We also started a major movement.
FRMC: That’s quite impressive. Can you talk about the role of clinical pathways in a PCMH?
PCMH capabilities facilitate adherence to clinical pathways. Both clinical pathways and the medical home model aim to streamline processes, and more consistently meet patient needs.
FRMC: And that must help improve care coordination.
FRMC: Can you give an example?
With clinical pathways, patients are more likely to have multidisciplinary assessments prior to initiating therapy. So, with breast cancer, for example, that means getting the patient in front of the surgeon, radiation oncologist, and medical oncologist. The order doesn’t matter, but they each need to evaluate the patient and then collaborate on a plan.
FRMC: That doesn’t happen in conventional settings?
There are a lot of programs where patients may see only the surgeon. They sometimes don’t see a medical oncologist until after surgery and after high dose radiation therapy is given. A clinical pathway requiring a multimodality collaboration can help to optimize care delivery and coordination.
FRMC: Can you give an example of how care coordination affects treatment?
Since we initially started taking a more structured, multidisciplinary approach to breast cancer in the 1990s, we have found that, 70% of the time, there are modifications to the treatment plan based on having an open discussion with the entire care team, including the surgical, medical, and radiation oncologists; the pathologist; and the radiologist. Some of the modifications were major; others were minor but meaningful.
This standardized process epitomizes the broader concept of a clinical pathway.