Cancer Center Works to Foster Collaboration among Oncology Care Providers

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Steven-D'Amato-thumbSteven L. D’Amato, Executive Director

As the largest private practice in Maine, the Maine Center for Cancer Medicine & Blood Disorders (MCCM) has four locations throughout the state: Biddeford, Brunswick, Sanford, and Scarborough.

Steven L. D’Amato has been MCCM’s executive director since 2011. D’Amato is a pharmacist by training, and early in his career, he developed the hospital oncology pharmacy program for Maine Medical Center in Portland. After spending 23 years in the hospital system, he was hired as a full-time oncology pharmacist at the Maine Center for Cancer Medicine & Blood Disorders.

D’Amato said he learned how to manage oncology services on the job, mainly through attending multiple national meetings and immersing himself in the specialty’s business and finance sides. When MCCM’s first executive director left for other opportunities, he accepted the position as an interim, eventually transitioning into the role on a permanent basis.

As a board-certified oncology pharmacist through the American College of Clinical Pharmacy, D’Amato brings both a medical and a business perspective to MCCM.

Participating in the Come Home Project

Currently, D’Amato said MCCM is involved in several progressive and innovative projects, not the least of which is the Come Home Project spearheaded by New Mexico Oncology Hematology Consultants, Ltd. and Dr. Barbara L. McAneny.

Funded by a $19.8-million grant from the Center for Medicare & Medicaid Innovation, the program includes MCCM, the New Mexico Cancer Center, and five other like practices. Come Home is managing patient toxicities through the development and implementation of standardized triage pathways for all types of symptom management.

The overarching goal of Come Home is to bring patients to the clinic in real time for urgent-care visits rather than forcing them to use the ER or be hospitalized, thus reducing admissions and readmission rates. The patients are managed by a dedicated nurse triage team who determine how their pathway of care should be executed. If the team does have to admit patients, the clinic can do so by a direct admit, thus bypassing the ER.

The physicians participating in the Come Home Project have also developed standardized treatment pathways for disease management. The adherence to these pathways will also be measured.

D’Amato said that part of this program involved extending clinic hours on weekdays and opening the doors on weekends, and so far, it has been hugely successful.

“It’s not an easy thing to accomplish. There’s a lot of staffing and scheduling issues that come into play to implement such a system, and we’ve done that effectively. The biggest plus has been the positive feedback from the patients. The patients absolutely love it.”

Data from every call and intervention at each of the seven participating practices is captured electronically by the software company, Net.Orange, and aggregated and presented to CMS.

“The whole design of the Come Home Project is to demonstrate to CMS that community oncology can provide a quality cost-effective service for the public and to develop alternative payment models,” D’Amato said, adding that he plans to continue with the Come Home model even after the grant has expired.

MCCM is also working with WellPoint and IBM to develop its Watson technology for medical-oncology management. MCCM’s physicians have been engaging with IBM engineers for over a year.

“The goal is to bring Watson to a place where it could be a powerful support tool for the clinical oncologist in helping to analyze the world’s literature, along with the patient’s demographic and complete medical profile, to give the clinician a sense of what the best treatment would be for that patient,” he explained. “It’s a way’s off, but it’s a very exciting project.”

Integrating cancer care with primary care

D’Amato said MCCM is developing a survivorship pilot project that will integrate cancer care with primary care from the outset of a patient’s treatment.

“When we have a patient come into our clinic who has been diagnosed with a malignancy, we establish a plan of care,” he said. “The idea is after the second or third visit where the patient presents to us and starts treatment is that we establish a follow-up appointment with their primary-care physician where the oncologist can lay out the treatment plan for the PCP. We involve the PCP from the beginning with the patient’s treatment plan so there’s that tight integration between primary care and medical oncology.”

To further cement this collaboration, MCCM plans to work with primary care to integrate medical records to enhance information exchange.

“The thought here is you eliminate duplication of tests and also bring the PCP in tune with the patient’s treatment to more effectively manage that type of patient’s care and avoid any complications,” D’Amato said, adding that MCCM’s ultimate goal is to be a certified oncology medical home.

Establishing a nimble and adaptable culture

During his time with MCCM, D’Amato has worked with the organization’s president, Dr. Tracy Weisberg, to internally instill within MCCM a culture of quality, compassion, innovation, and accountability. Integral to this culture change was the establishment of a leadership team able to be nimble and adapt to the many changes in oncology.

“We’ve really done a good job to put our house in order,” D’Amato said, “to make sure we have all of the quality personnel that we need, and that’s from physicians on down, and to make sure we have the right players who embrace our vision and goals.”

Moving forward, he wants to extend his team’s effectiveness to foster a collaborative spirit with other healthcare entities in MCCM’s service areas.

“As we all know, payment reform is upon us, and I think that we all need to work collaboratively, whether it’s in a hospital system or private-practice system or community system. We all have to work together, regardless of your interest and your business model. There has to be an alignment to bring down the costs in healthcare. It’s integration of medical records, partnering with different organizations on how to deliver the best cost-conscious, high-value quality care possible, and to establish metrics that can be measured to ascertain that the things that we’re doing are working.”

-by Pete Fernbaugh

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