Cancer Clinical Summary

How the Program Works | Facts You Need to Know | Clinical Treatment Guidelines | Outcomes Measurement | Cancer Outcomes

How the Program Works

Cancer is an acute condition requiring care management for a short but intense period of time, usually from three to nine months, starting at the time of diagnosis and continuing throughout the follow-up process.

Each patient in Matria’s Cancer Management Program is assigned a care manager and has access to a nurse 24 hours a day, seven days a week, via a toll-free number. Responsible for coordinating the patient's ongoing care, our care managers are nurses specializing in oncology in a variety of cancer treatment settings, with an average of 10 years of experience.

Care managers report to the patient's primary care treating physician as appropriate based on the patient's clinical situation. They discuss treatment options with patients and their families, answer questions and provide appropriate educational materials as well as support.

In addition, care managers work collaboratively to:

• Identify the most comfortable and cost-effective setting for all treatments and procedures, with no negative impact on efficacy
• Help patients understand their health plan's benefits
• Provide emotional support
• Recommend covered services, such as home healthcare, when appropriate
• Recommend local tumor-specific patient support groups
• Educate regarding diagnosis and symptom management
• Ensure that patients and providers are adhering to the treatment plan by remaining in periodic contact with family members
• Check progress of the case
• Update the patient's electronic case file
• Monitor treatment compliance with the clinical treatment guidelines (see below)
• Facilitate communication with physicians

Facts You Need to Know

Cancer is the second leading cause of death in the United States, exceeded only by heart disease. Roughly 1.3 million new cancer cases are diagnosed each year, costing the United States $180 billion in healthcare costs. One out of every four deaths in the United States is from cancer. Smoking causes one-third of all cancer deaths.

In America, half of all men and one-third of all women will get cancer during their lifetime. About 77 percent of all cancers are diagnosed in people 55 years of age or older.

Clinical Treatment Guidelines

Improved clinical care leads to cost savings. That's why Matria’s comprehensive treatment guidelines are based on the latest research and practice evidence.

Oncology physicians dedicated more than 20,000 hours to create our treatment guidelines. They are validated by a consensus of community and academic-based oncologists, continuously updated in monthly guideline committee meetings and ratified by our Clinical Advisory Board, which is made up of national oncology experts.

Based on the cancer site and stage, the treatment guidelines detail the most efficacious and cost-effective treatment plan, ensuring that the patient receives the right care, at the right time, in the most appropriate setting. The guidelines are tracked in our electronic patient case file. Any proposed treatment that deviates from the "best practice" guideline prompts an intervention by a medical director to ensure that the deviation is warranted.

Outcomes Measurement

Clinical treatment guidelines, cost and utilization data and electronic patient case files are all housed in our state-of-the-art, proprietary Web-based information system. Care managers use our Integrated Care Management (ICM) system to record and monitor each activity related to the patient's care and measure treatment progress against our treatment guidelines. The ICM system, backed by a high-end data warehouse, generates comprehensive, real-time reports monitoring a wide array of clinical and financial outcomes. These include:

• Patient re-hospitalizations
• Side effects
• Remission rates
• Patient and physician satisfaction
• Reduction of diagnostic testing duplications
• Integration of care from diagnosis onward
• Conservation of hospital resources
• Accountability and performance of attending oncologists

Cancer Outcomes

Matria’s Cancer Management Program produced the following results for a range of clients:

• Reduced hospital days by 16 percent
• Reduced hospital admissions by 18.3 percent
• Reduced emergency room visits by 8 percent
• Reduced cancer readmissions of all admits