Episodes of Care Program Gives Cancer Patients the Care They Need
At Astera Cancer Care (Astera), a new Episodes of Care (EOC) program is transforming the way patients with certain complex cancers receive comprehensive cancer care.
Medical Oncologist Edward J. Licitra, M.D., Ph.D. is the Chairman and Chief Executive Officer at Astera, a physician-owned multi-specialty community oncology practice serving more than 16,000 new patients annually in throughout New Jersey. He knows all too well that patients newly diagnosed with cancer are often overwhelmed, scared and unsure of what to do next, and need special attention and guidance as they move forward with treatment. But that's not typically the case in a traditional fee-for-service payment environment, which can create barriers and delays to treatment.
“Patients with cancer deserve to understand what is going on, and to get the treatment started as quickly as possible. The fee-for-service system of reimbursement doesn't really allow us to do that well,” Dr. Licitra said. “The perfect health care delivery system removes the barriers to getting patients what they need as quickly possible and helps relieve the emotional and financial toxicity of cancer. That's what the episodes of care model with Horizon achieves.”
The EOC model gives cancer patients access to the specialized care they need from the moment they are diagnosed, through their treatment journey and during active recovery, Dr. Licitra explained.
Building Episodes of Care for Cancer
The cancer EOC program at Astera was developed through a collaboration between Astera, OneOncology and Horizon, who continue to work together to build and improve optimal treatment plans for various types of cancer. The episodes include breast, lung, prostate, colon, rectal, multiple myeloma and head and neck cancers and the number is rapidly expanding.
Because this cancer EOC program is a prospective payment model, providers are paid up front for a defined part of the patient's treatment.
“The prospective payment model, the way that it's operationalized and its collaborative nature of the relationship between the payer and the provider, is unique and delivers incredible value to patients,” Dr. Licitra said.
When developing an EOC to manage cancer treatment, the EOC team considers all aspects of a patient's medical and health needs and relies on Horizon's data to pull together the best treatments and support services for that particular cancer.
“When we're building the programs, we give providers sufficient tools to be able to do their jobs and help patients,” said Cathy Sherman-Ostrow, Manager of Provider Partnerships, Contracting, and New Models at Horizon. “It makes the job easier for physicians, improves outcomes and helps members get the most for their benefit dollars.”
Value-Added Benefits of Astera's EOC Programs
Astera, through its partnership with Thyme Care, assigns new patients their own “concierge navigator,” who guides the patient and serves as their advocate throughout their treatment and recovery journey.
“Astera is at the front line of a different type of cancer care where they help patients navigate and get to the right therapy, at the right time,” Sherman-Ostrow said.
Each EOC program provides patients with the oncology treatment and rehabilitative care they need, and includes specialized support services unique to their cancer.
“Part of the goal is to make sure that we invent lots of value-added services for patients,” Dr. Licitra said. “The great thing about this partnership is we're always looking at ways to build these types of services into the episode.”
For example, Astera's head and neck EOC program supports patients with their nutritional needs by offering the Cancer Oriented Personalized Eating and Emotional Support (COPES) program.
“When patients get radiation, which burns their mouth and throat, we have to make sure they maintain their nutrition,” Dr. Licitra said. “COPES enables us to keep patients stable and helps them have a better journey.”
Astera's prostate EOC program includes a value add that helps alleviate the long-term effects of radiation treatment once a patient is in active recovery.
“We're not only thinking about the care patients get today, but thinking about the side effects they may experience in the future. It's unfortunate that when someone's cured of a particular cancer, they later have to deal with some side effects for the next 30 or more years of their life. By working collaboratively with payers and embedding some of these important value-added services into the episode, you may get a better outcome. It's a concrete example of the way that we're trying to reinvent cancer care,” Dr. Licitra said.
Astera also offers innovative cancer treatments, including a community-based chimeric antigen receptor (CAR) T-cell therapy, which can be administered onsite at Astera offices, rather than in the hospital.
“We are really transforming health care delivery to patients with cancer in a way that everybody benefits and everybody's incentives are fully aligned.” Dr. Licitra said.