Major Markets

Coreo understands that the major measures involved with cancer treatment are:

  • Utilization (e.g., unplanned hospitalizations; 30, 60, 90-Day readmissions; length of stay; emergency room visits; ICU; urgent care; ambulatory care visits; admission to acute care facilities; adverse events)
  • Quality
  • Patient Satisfaction
  • Patient Outcomes
  • Costs

Of course, these measures inter-relate to one another.

The major markets that bear the responsibility for these measures are:

Health Systems and Hospitals

Health Systems and Hospitals house a large portion of the oncology clinics and operations and are concerned with quality ratings, utilization, and adhering to compliance with quality metrics.

Cancer Centers

Cancer Centers are often at the forefront of cancer care bearing cost burdens that impact their ability to provide accessible, high-quality care. This leaves many to seek partnerships with government agencies, research organizations, and philanthropic donors to help alleviate financial challenges.

Physician Organizations

Physician Organizations, particularly those specializing in oncology and involved with value-based care, also need to manage to these measures.

Health Plans (Fully-Insured Business)

Health Plans (Fully-Insured Business) can be ultimately responsible for costs associated with cancer patients across the care continuum (e.g., at time of diagnosis, treatment, management, adverse advents arising, commodities exacerbated).

Administrative Services Only (ASO) Health Plans

Administrative Services Only (ASO) Health Plans do not bear the cost of cancer patients; however, they are always looking for added services to help satisfy their self-insured companies. Since cancer costs can be extensive, this service will provide differentiation to keep the self-insured employers with their plan.

Self-Insured Employers

Self-Insured Employers like health plans, bear the costs of their employees and retirees.

All of these markets care deeply about patient lives and patient satisfaction rates.

Digital oncology-specific solutions have seen increased market activity and investment as the shift to value-based care creates an inherent need for enhanced digital technology infrastructure.¹ Coreo’s technology-enabled oncology care management solution supports providers in meeting quality metrics and payer incentivized models, as these markets embrace transition from fee-for-service to value-based care.

Coreo’s conceptualization and programmatic design is modeled to support the Academy of Oncology Nurse and Patient Navigator’s (AONN+) 35 standardized, evidence-based navigation metrics in the area of patient experience, clinical outcomes, and return on investment.1-3 The AONN+ metrics are supported by more than 275 value-based cancer care metrics and oncology national standards.³

The Centers for Medicare & Medicaid Services is including reimbursement for Oncology Patient Navigation in the2024 Medicare Physician Fee Schedule Proposal. It is being recognized that prioritizing patient navigation is particularly important to achieve the President’s Cancer Moonshot goals.

References

  1. Strusowski, T., Sein, E., & Johnston, D. (2017). Academy of Oncology Nurse & Patient Navigators Announces Standardized Navigation Metrics. Journal of Oncology Navigation & Survivorship, 8 (2), 62-68.
  2. AONN+ & the American Cancer Society 2020 Navigation Metrics Toolkit. (2020). https://www.aonnonline.org/images/resources/navigation_tools/2020-AONN-Navigation-Metrics-Toolkit.pdf
  3. Strusowski, T. (2020). Building the Case: Oncology Patient Navigation and Payer Engagement. Oncology Practice Management, 10 (5). https://oncpracticemanagement.com/issues/2020/may-2020-vol-10-no-5/1596:building-the-case-oncology-patient-navigation-and-payer-engagement