Apr 23, 2018
Practical, personalized recommendations for practice improvement
By Rachel Martin, ASCO Communications, and Elaine Towle, ASCO Clinical Affairs
Peter Paul Yu, MD, FACP, FASCO, is the physician in chief at the Hartford HealthCare Cancer Institute, an integrated health care system working to establish an oncology service line that promotes a single standard of care delivery.
To further develop this effort, Dr. Yu enlisted ASCO Practice Consulting Services and Support, which provides comprehensive, personalized support to help practices improve their business operations and prepare for the transformation from volume- to value-based care. The specialized team of consultants, made up of nationally recognized experts in oncology practice management, is dedicated to helping practices succeed in today’s changing health care environment. Services include readiness assessment for value-based care and the Quality Payment Program (QPP), practice operational assessment, practice transformation implementation support, analytical services, and triage pathways support.
In the following interview, Dr. Yu shares his experience working with ASCO Practice Consulting Services and Support as a trusted partner in Hartford HealthCare Cancer Institute’s efforts to deliver the highest quality and value of patient-centered care.
Tell us about your practice. How many physicians do you have? How many patients do you typically see each year?
PY: Hartford HealthCare (HHC) is an integrated delivery network which cares for 6,000 analytic cancer patients per year. HHC includes six hospitals, 40 medical oncologists, and five gynecologic oncologists working in a mixture of foundation and private practice models. Cancer surgery is provided by fellowship-trained surgeons in breast, colorectal, thoracic, head and neck, urologic, neurosurgical, orthopedic, and surgical oncology. Overseeing cancer services is the HHC Cancer Institute, which horizontally integrates oncology across medical, surgical, and radiation oncology, along with pathology and other cancer-related services.
In 2014, HHC Cancer Institute and Memorial Sloan Kettering (MSK) created the MSK Cancer Alliance to accelerate knowledge transfer and redesign the clinical trials research enterprise through the implementation of a new model for academic medical center and community health care system collaboration.
What specific challenges were you facing that led you to reach out to ASCO for consulting services?
PY: The HHC Cancer Institute has eight practice sites with several more opening. Prior to forming the cancer institute, these sites functioned independently for many years. One of the principles for creating a health care network is to improve the quality of patient care, optimize the efficiency of workflows, and provide a consistent, superior patient experience. However, given the legacy practices that came together over a short period of time, we anticipated that close examination would find significant practice variation. Some of this variation would be unwarranted in the sense that it was inconsistent with what is known about best practices in oncology care. Other variation might demonstrate that one practice had discovered a better way of doing things, which could be leveraged across sites. In particular, we were interested in understanding the work that we needed to do to deliver a patient-centric oncology medical home model.
What steps did ASCO take to help you and your practice?
PY: We needed a knowledgeable and trusted consultant to take a deep dive into the operations of our ambulatory oncology offices and infusion centers and provide an objective comparison to the experiences of oncology practices across the country.
As someone relatively new to the cancer institute, I needed to work with people I had complete confidence in to serve as my eyes and ears as they spent days observing patient care and how the oncology teams worked together. As an ASCO volunteer, I had many years of experience working alongside the members of what is now the ASCO Clinical Affairs Department, and I was involved in launching this new ASCO department.
At HHC, we offered ASCO Practice Consulting Services and Support to all of our oncology offices, and six of the eight sites took advantage of the opportunity. Over 3 months, ASCO consultants made three assessment trips, with each trip lasting 2 to 3 days. They visited and observed the practice for patient flow, roles and responsibilities of the clinic team, how clinicians interacted with each other around patients, staffing levels, and physical layout of the offices. The ASCO consultants spent time interviewing practitioners and administrators.
All of this was rolled up into both a scorecard and multiple-page narrative assessment for each site. Within this assessment, the consultants made practical and concrete recommendations to improve the patient experience, quality of care, staffing satisfaction, financial performance, and a marketing analysis for practice growth opportunities. Overall, these recommendations were of extremely high utility and on target.
What steps did you take after the readiness and operational assessment?
PY: The ASCO assessment is an early step in our practice change management. We started by sharing these assessments with site leadership and with system leadership. We knew it was important to get their buy-in, because while some improvements can be made at the practice level, others will require capital investment to redesign or create new facilities, which will need to go through our budgeting process. Other changes will impact the hospitals and medical group operations. Lessons learned in medical oncology are directly relevant to other ambulatory settings that treat patients with complex, chronic diseases.
We have begun to redefine the relationships between members of the oncology team so that everyone is working at the top of their license and providing a more seamless patient experience where handoffs don’t result in delays or missed work. Our administrators have a much deeper understanding of the needs of the practices and what support is required to improve not only the lives of our patients, but also the professional satisfaction of the care team in the work they do for our patients.
What other changes do you hope to make?
PY: The ASCO assessments showed that we have much work ahead of us. Selecting where to start will be a combination of identifying low-hanging fruit and mission-critical challenges. We will be engaging ASCO Practice Consulting Services and Support to work with us to create a standard work process for implementing practice improvement initiatives.
At HHC we have two significant internal resources that we will draw upon as we work to make these changes. First, we are supported by a system Lean Management (process improvement) team, and had already begun to train our clinicians and administrators in Lean techniques for process improvement.
Second, we have a new department for improving the patient experience. This will add another dimension to our quality improvement efforts as we re-engineer ourselves for a world where quality improvement is increasingly defined by health economics, outcomes perspectives, and success in achieving more patient-centered care.
What would you tell other practices about your experience?
PY: ASCO Practice Consulting Services and Support provides a detailed and insightful assessment that is a solid foundation for obtaining a higher performance level in patient-centered, value-based oncologic care. Bringing in our professional society—whose mission is to serve its members and help us thrive in the challenging environment that we all face—has been a very positive experience for our providers and administrators.
Improve Your Practice Operations With ASCO Consulting Services
The ASCO Clinical Affairs Department provides cross-cutting, comprehensive, personalized consulting services for oncology practices across the United States.
- Readiness assessment, focused on preparing practices for value-based care, new payment models, and success in the Quality Payment Program.
- Practice operational assessment, a comprehensive practice review focused on process efficiency, staffing efficiency, and financial management.
- Practice transformation implementation support, services designed to meet your practice’s specific needs in the transformation from volume- to value-based care.
- Analytical services, practical data analytics—financial, clinical, operational—to support business operations.
- Triage pathways, a decision support tool to help your patients get the right care at the right time in the right place. ASCO Practice Consulting Services and Support can help you prepare for effective implementation of triage pathways
In addition, ASCO can help you unlock valuable data to assist your practice in providing high-quality cancer care with the ASCO Clinical Affairs Data Warehouse. The data warehouse supports Clinical Affairs’ work including consulting services, analysis projects, and PracticeNET. The data warehouse includes:
- Survey data
- Practice data
- Publicly available Medicare data
ASCO ensures the confidentiality and protection of all of the practice data. To learn more about ASCO Practice Consulting Services and Support, visit practice.asco.org or email firstname.lastname@example.org.