Team-Based Approach to Managed Specialty Care

NORWALK, Conn—A new team-based program instituted by Oxford Health Plans, Inc. is returning clinical autonomy to the specialists delivering care. Oxford has recently formed a subsidiary company—Oxford Specialty Management—through which integrated medical teams will deliver specialized patient care. To date, these teams have been established in 10 medical specialties, and more than 700 specialists have joined the program.

“By allowing a specialty team to be responsible for patient care, we are returning the decision-making authority to the specialists,” Todd Farha, CEO of Oxford Specialty Management, said in an interview with Oncology News International. This approach focuses on coordinated patient care, an aspect of health care that is a key concern to patients undergoing complex treatments, he said.

“By contracting with groups of specialists to treat specific diseases,” Mr. Farha added, “we have eliminated the need for patients to get approvals from their primary care physician each time a specialist or an additional test is required.”

The Oxford team strategy also emphasizes patient education and involvement. Built into this system is a data base of academic and medical credentials of team members that patients and their primary care physicians can consult in choosing a specialty team.

In addition, Oxford requires patient satisfaction questionnaires to be submitted after treatment is completed, and patients and physicians may review these data to help them select a team that is best suited to the patient’s individual case.

Urology Teams: An Example

John H. Hajjar, MD, chief of urology, St. Joseph’s Hospital, Patterson, NJ, said that, in his experience, both patients and physicians are pleased with how this approach is working. Currently, there are seven urology specialty teams in the New York metropolitan area, with additional teams being formed.

In a separate interview, Dr. Hajjar explained that as leader of a specialty team in urology, he is responsible for the treatment of prostate cancer. He leads a team composed of radiation therapists, a pathologist, a radiologist, and a local community hospital with all its supportive facilities and staff.

“Once a diagnosis of cancer has been determined by my team, we meet to discuss the best course of treatment for the patient. We then counsel the patient about treatment options, provide educational materials about the patient’s condition, and report the patient’s decisions about treatment to the primary care physician, both initially and throughout the case,” Dr. Hajjar said.

He said that within this team approach, prostate cancer treatment is divided into four stages: diagnostic, curative, observational, and hormonal. “The curative stage includes surgery and/or radiation therapy and is allotted 6 months’ treatment time,” he said, adding that one year is allotted for both the observational and hormonal stages.

The incentive for the specialist is to provide expert care efficiently. For example, Dr. Hajjar said that for a radical prostatectomy, his team is paid for 4.5 days of care (the national average).

If the inhospital stay exceeds 4.5 days, team physicians are held responsible for all costs over that time period, but if the patient can safely leave the hospital in fewer days, the physicians can use this time to treat those patients who require longer inhospital stays.

Should the treatment require more than 7 days, Oxford pays for any costs incurred after the seventh day as a protection to the physicians involved.

Dr. Hajjar stated that this approach is not for everyone because physicians must be confident in their abilities and success rates in order to function effectively within this setting. He also pointed out that doctors should not feel threatened by this system because when the team has the appropriate skills, high-quality care can be given more efficiently.

Cost Containment

Because this program is designed to provide effective, coordinated specialty care, managed care companies can contain costs. “This system is working for the time being, but our contracts are negotiated on a yearly basis,” Dr. Hajjar said. This arrangement has caused some concern about possible future reductions in fees.

Nonetheless, he said, the Oxford formula seems workable. If the level of care is consistently high and patients are satisfied, it is likely that patients will be attracted to the program.

Increasing numbers of patients would mean higher revenues for Oxford, and efficient teams of physicians could expect to be fairly compensated, he noted.

Early experience seems to confirm that complex cancer cases can be effectively managed by specialized teams in a system that links patient satisfaction to expert care. Said Dr. Hajjar: “My team has treated seven prostate cancer patients so far, and each patient is very satisfied. We are delivering quality care without being told what to do, so these are good changes.”