Payment and Care for Hematopoietic Cell Transplantation Patients

Toward a Specialized Medical Home for Complex Care Patients

James L. Gajewski, Mark B. McClellan, Navneet S. Majhail, Parameswaran N. Hari, Christopher N. Bredeson, Richard Maziarz, Charles F. LeMaistre, Michael C. Lill, Stephanie H. Farnia, Krishna V. Komanduri, Michael J. Boo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StateAccepted/In press - Jul 17 2016

Fingerprint

Patient-Centered Care
Cell Transplantation
Home Care Services
Accreditation
Therapeutic Human Experimentation
Stem Cell Research
Health Insurance
Ambulatory Care
Disease Management
Contracts
Cell- and Tissue-Based Therapy
Medicare
Population
Inpatients
Primary Health Care
Patient Care
Databases
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • HCT
  • MACRA
  • Payment
  • Specialty medical home

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Payment and Care for Hematopoietic Cell Transplantation Patients : Toward a Specialized Medical Home for Complex Care Patients. / Gajewski, James L.; McClellan, Mark B.; Majhail, Navneet S.; Hari, Parameswaran N.; Bredeson, Christopher N.; Maziarz, Richard; LeMaistre, Charles F.; Lill, Michael C.; Farnia, Stephanie H.; Komanduri, Krishna V.; Boo, Michael J.

In: Biology of Blood and Marrow Transplantation, 17.07.2016.

Research output: Contribution to journalArticle

Gajewski, James L. ; McClellan, Mark B. ; Majhail, Navneet S. ; Hari, Parameswaran N. ; Bredeson, Christopher N. ; Maziarz, Richard ; LeMaistre, Charles F. ; Lill, Michael C. ; Farnia, Stephanie H. ; Komanduri, Krishna V. ; Boo, Michael J. / Payment and Care for Hematopoietic Cell Transplantation Patients : Toward a Specialized Medical Home for Complex Care Patients. In: Biology of Blood and Marrow Transplantation. 2016.
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