A team of investigators led by Dr. Teresa M. Waters of the University of Kentucky College of Public Health examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality. The results of their study appear in the Journal of Oncology Practice. Co-authors are Dr. Cameron M. Kaplan and Dr. Ilana Graetz, University of Tennessee Health Science Center; Ms. Mary M. Price, Mongan Institute, Massachusetts General Hospital; Dr. Barbara L. McAneny, Innovative Oncology Business Solutions, New Mexico Oncology Hematology Consultants; and Ms. Laura A. Stevens, Innovative Oncology Business Solutions.
Researchers compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma, and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for clinical and sociodemographic differences. The primary outcome was six-month medical spending per beneficiary. Secondary outcomes included six-month out-of-pocket spending, inpatient and ambulatory care–sensitive hospitalizations, readmissions, length of stay, and emergency department and evaluation and management visits.
The investigators found that before COME HOME, six-month medical spending was $2,975 higher for the study group compared with controls and increasing at a similar rate. After intervention, this difference was reduced to $318, a significant change of $2,657, or 8.1 percent savings relative to six-month average spending. COME HOME was also associated with a significant 10.2 percent reduction in emergency department visits per 1,000 patients per six-month period.There were no statistically significant differences in other outcomes.
Overall, COME HOME was associated with reduced Medicare spending and improved emergency department use. Investigators note that while improvements were not uniform, the patient-centered medical home model holds promise for oncology practices.