TY - JOUR
T1 - Payment and Care for Hematopoietic Cell Transplantation Patients
T2 - Toward a Specialized Medical Home for Complex Care Patients
AU - Gajewski, James L.
AU - McClellan, Mark B.
AU - Majhail, Navneet S.
AU - Hari, Parameswaran N.
AU - Bredeson, Christopher N.
AU - Maziarz, Richard T.
AU - LeMaistre, Charles F.
AU - Lill, Michael C.
AU - Farnia, Stephanie H.
AU - Komanduri, Krishna V.
AU - Boo, Michael J.
N1 - Funding Information:
Starting in 1972 the HCT as a community created and maintained an outcomes data registry, which is currently administered by the CIBMTR, to improve HCT access and outcomes. The CIBMTR has for much of its existence received funding from the National Institutes of Health and other federal agencies to support the registry as well as research using registry data. Currently, this registry collects outcomes data on virtually all allogeneic transplants performed in the United States and over 80% of all autologous HCT in the United States [49-51] . It also collects outcomes data from many transplant centers outside the United States. Under contract with the Health Resources and Services Administration, which is a part of the US Department of Health and Human Services, the CIBMTR develops and publishes center-specific outcomes data on all allogeneic HCT activity in the United States.
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
KW - HCT
KW - MACRA
KW - Payment
KW - Specialty medical home
UR - http://www.scopus.com/inward/record.url?scp=85033395802&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85033395802&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.09.012
DO - 10.1016/j.bbmt.2017.09.012
M3 - Article
C2 - 28963077
AN - SCOPUS:85033395802
VL - 24
SP - 4
EP - 12
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 1
ER -