By Sarianne Gruber
Twitter: @subtleimpact
COTA, Inc. started as home grown database by and for the internal team of John Theurer Cancer Center (JTCC) oncologists and hematologists to help them access patient data for research. Even though patient data was starting to be funneled through the electronic medical records and ICD-9 (and ICD-10) codes label the general disease, there was no functionality in place to bridge the information into a meaningful platform. The doctors wanted to be able to benchmark themselves against their peers, to track and segment patients by “oncologic sense” such as disease stages and biomarkers as well as treatment type and, of course, outcomes. The team went back to their medical textbooks to create a comprehensive template for all general cancer types with the drill down ability to segment patients on choice variables. What seemed so logical, a missing link, create specific disease tracks for treating cancer patients soon burgeoned into powerful tool. “With the expansion [to the Regional Cancer Care Associate (RCCA) practices], the database would now have doctors with different levels of expertise, covering different geographic areas and different referral patterns. So we started searching the possibility to include data from all of these different hospitals. We also had to learn how to work with different EHRs because you are working with different hospitals, then we could start to see true outcomes”, recounted Dr. Goldberg. For example, the National Comprehensive Cancer Network guidelines for patients with stage 4 adenocarcinoma, one of the more common types of lung cancer, purports looking for tumor markers EGFR and ALK. Although it is small subset of the population, targeted pill therapies can improve outcomes and avoid chemotherapy. For three year period, participating RCCA doctors pooled over 700 criteria matched patients about to be offered their first treatment. The data revealed that 60% of patients had appropriate genetic profiling, and the remaining 40%, a relatively big gap, didn’t have the test done. It is hoped that peer feedback and outcomes will motivate continuous improvement. Though, “COTA still gives the doctors the freedom to decide their own best practices”, commented Dr. Goldberg.
Payers, Bundled Payments and a Referee
COTA has one of the first bundled care payments in the United States. Two entities, Horizon Blue Cross Blue Shield of New Jersey, a major strategic COTA investor, and the RCCA physician practices of New Jersey, have entered into bundled contracts for a number of diseases. In September of last year, COTA started a bundled project for breast cancer. A doctor selects the appropriate treatment for a woman with early stage breast cancer with hormones, chemotherapy, or chemotherapy with herceptin antibody. Horizon BCBS and RCCA have negotiated a payment system for each of those major bundles for delivery of care. If a hormone only therapy is selected, Horizon BCBS pays the doctor a set fee to take care of the patient for next six months. COTA reports to the payer whether that practice has met the measures and has delivered therapy that is in the contract. Then COTA turns around and tell the doctors, this is how much you are being paid in the contract, whether a doctor is going over and why, such as using more growth factors then the other people in this practice. “COTA helps medical practices stay in budget. We compare them to their other colleagues, so they know how they are doing not just financials but also quality and outcomes. We try to give both sides the information they need so they can come together. And both sides have actually been very happy with us. Horizon BCBS in the long run feels they will save money with us”, voiced Dr. Goldberg.
The COTA Uber Plan: Treatments, Patients and Apps
COTA’s vision for the future, as expressed by Dr. Goldberg, is for a patient who develops a cancer, which is a very trying time for the patient, to be able to questions like “how do I know what doctor to see”. We envision having an app and the patient can but in their type of lung cancer or breast cancer and get a list of things that are important to them. And with a few more clicks on their iPhone be able to see how doctors are doing in their region with that particular diagnosis. “We want transparency and we believe that will drive physicians to do better”, stated Dr. Goldberg.
About the John Theurer Cancer Center, Regional Cancer Care Associates
The John Theurer Cancer center is a disease-specific organization. Twelve divisions include multiple myeloma, gynecologic oncology, lymphoma, neurological oncology, gastrointestinal oncology, thoracic oncology, breast, leukemia, skin and sarcoma, geriatric oncology, head and neck and urologic oncology. Each specific expert group has over 30 physicians with their own specific areas and expertise. On average 7,000 brand new patients are treated per year at the JTCC, ranking them in the top 10 cancer centers in the United States. The JTCC oncologists and hematologists participate in the Regional Cancer Care Associates. The practice extends across the entire state and treats approximately 60% of all cancer cases in New Jersey. More information is available on their website.
To learn more about COTA and Dr. Stuart Goldberg, please visit the Cancer Outcomes Tracking and Analysis website.