Physicians build bundled payments system for breast cancer

HIMSS18 presenters explain how Hackensack Meridian matches precision payment to precision medicine with an innovative approach to create ‘lanes of care’ that determine efficacy in terms of both cost and outcomes.
By Susan Morse
11:42 AM
precision medicine bundled payments

Physicians Andrew Pecora and Stuart Goldberg of Hackensack Meridian Health have created a precise disease classification system for use in bundled payments around breast cancer treatment that is getting national attention.

Hackensack in New Jersey created the system with data analytics partner Cota, and has identified 450 distinct patient types from a three-year review of breast cancer patients. The physicians also tracked the various methods used for treatment.

From this, Pecora and Goldberg created the lanes of care that had the best outcomes. When lanes had similar results, they looked at which ones were most cost-effective. 

“We know that two-thirds of what we do in healthcare is the best in the world. About a third is not the right thing and it’s resulting in excess expenditures and not good outcomes,” said Pecora, who serves as President of the Physician Services Division and Chief Innovation Officer at Hackensack. 

For breast cancer, a physician may treat with surgery only, surgery then hormones, radiation, or from among literally a thousand options.

[Also: eClinicalWorks to show off precision medicine, AI features for EHR at HIMSS18]

To narrow which treatment worked best, patients were given a numeric code that defined the person, disease and therapy.  Similar patients shared the same number and were treated by the various methods that had always been employed.

“We were able to see all of this variance,” Pecora said. “We can show doctors, over the last three years, this is what you did. Why not put (the patient) in this lane? We think we can save 20 percent on total spend for any cancer. And have better outcomes for patients.”

Cota’s new disease classification system uses EHR data to standardize care. 

“We now have the ability going through the data, where there is variability in what we’re doing, to narrow that variance,” said Goldberg, who serves as CMO. “The aim is to more precisely define a patient population, identify the variances in the outcomes in cost and attack the variances.”

The Medicare mandatory pilot for breast cancer bundles in the state began on January 10 in collaboration with Horizon Blue Cross Blue Shield of New Jersey. 

The patented disease classification system for bundled payments has gone to the Department of Health and Human Services for review for potential use nationwide. Pecora and Goldberg may know the results by the time of their HIMSS18 session in March.

“This is one of the bigger projects in the country,” Goldberg said.

The session “Precise Disease Classification Optimizes Bundled Payments” takes place at 8:30 a.m. March 7 in Las Vegas at the Venetian Convention Center-Sands Showroom.

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Twitter: @SusanJMorse
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