Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending

Background: Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly. Objective: We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending. Methods: Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models. Results: In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/ quarter, respectively; P< 0.01). In addition, COME HOME had lower spending ($ 675 per patient/ quarter; P< 0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/ quarter; P< 0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/ quarter, respectively; P< 0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/ quarter; P< 0.05), than comparison patients. Conclusions: The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.