Building a provider network based on quality: The Moffitt Oncology Network initiative

49

Background: Before entering into risk bearing contracts with payors, ACOs are challenged to find a basis for forming partnerships. Specialty ACO networks, in particular, must find ways to provide a common, high standard of care among a typically varied set of partners. The Moffitt Oncology Network (MON) Initiative demonstrates a possible solution to forming a value based ACO network across a broad geographical area that is based upon using clinical pathways. Methods: Moffitt Cancer Center (MCC) has developed more than 24 different disease specific pathways. The MCC pathways translate evidence-based guidelines into personalized cancer care throughout the continuum of care from evaluation to treatment. MCC is using these pathways with other hospital systems and physician groups throughout the MON. To enhance the use of pathways in the MON, MCC uses Clinical Performance and Value (CPV) Vignettes. CPV’s, are virtual patient cases related to the specific clinical pathways. The report herein is on pathway implementation in several disease areas (breast, lung and gastrointestinal (GI) cancers) across multiple sites: Lehigh Valley Hospital (Pennsylvania), Norton Cancer Institute (Kentucky), and Space Coast Cancer Center (Florida). Results: Pathway based clinical care was measured at baseline using CPVs across disease and site (Table). A total of 67 breast cancer providers took 131 breast cancer vignettes; 35 lung cancer providers took 104 lung cancer vignettes; and to date 27 GI cancer providers have taken 54 GI vignettes. There is statistically significant variation in performance among providers and between sites. This is manifest in pathway-specified areas of work-up, diagnosis, and treatment. Conclusions: Fostering adoption of clinical pathways is a practical objective that can help guide the formation of an ACO oncology network. This may be useful for forming specialty ACOs that establish a standard of care and set the stage for adopting new payment models with payors. [Table: see text]

Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction

From October 1985 through October 1989, 87 patients underwent 105 intraluminal brachytherapy treatments for endobronchial or endotracheal malignant tumors. Low-dose rate iridium-192 seeds were used. Of the 60 patients treated for primary lung carcinoma, 52 patients (87%) had previously received full-course external beam radiotherapy to the tumor sites. Ten patients were treated for symptomatic metastatic disease, and one patient had extension of tumor into the trachea from carcinoma of the cervical esophagus. Clinical or bronchoscopic improvement was noted in 42 patients (59%). No significant difference in the response rate was observed between various types of tumor. Patients who were treated with a radiation dose larger than 2500 cGy at a 2 cm radius had a significantly greater response rate (77%) than patients treated with a dose less than 2500 cGy (38%) (p = 0.001). A trend toward better results was apparent in patients who had undergone Nd:YAG laser bronchoscopy in the 2 weeks before brachytherapy. The treatments were well tolerated, and the incidence of serious complications was low and acceptable.

Testicular seminoma. Results of a program of megavoltage irradiation

Between April 1962 and March 1984, 61 patients with a diagnosis of testicular seminoma were seen at Hahnemann University Hospital. Of these patients, 52 had long-term follow-up after definitive treatment with megavoltage irradiation. In 30 patients, disease was classified as stage I, in 21 patients, stage II, and in one patient, stage III. Treatment techniques are described. Overall relapse-free survival rate for all stages was 92% with an adjusted survival rate of 96%. Treatment policies for each stage are presented.