Texas Oncology Invests in Remote Monitoring: Faster Decision-Making, More Feedback From Patients

Texas Oncology’s quest to reduce hospitalizations and emergency department (ED) visits through value-based care started with a simple question: can do we a better job with patient phone calls?

Lalan Wilfong, MD, executive vice president of Value-Based Care and Quality Programs, described Texas Oncology’s challenge this week during the virtual meeting of the Association of Community Cancer Centers. Five years ago, when the 200-site community oncology network decided to take part in CMS’ Oncology Care Model, it had to step back and look at areas where patient experience fell short.

A top complaint: when patients called during business hours, it took too long for someone to get back to them. Patients would leave voicemails, and there was no system to track who picked up the voicemail or when.

“We didn’t have any insight at all about that,” Wilfong said. “What are nurses doing during the day? How are we holding them accountable for callback times?”

Right at that time, the first studies appeared showing the benefits of electronic patient reported outcomes, or ePROs, and Texas Oncology physicians also wondered how they could incorporate these new findings into patient care.

“How can we understand patients who are calling in with symptoms, and how do we make sure we’re responding appropriately?” Wilfong asked. “How do we have operational efficiency to utilize our staff most effectively, and improve our triage so that we’re managing patient symptoms most effectively, in a timely fashion, which ultimately leads to better symptom management and should lead to reduced ED visits and hospitalizations—then layering in at the very end, proactive care, where patients can self-report things to speed up the process?”

In July 2019, Texas Oncology selected the Navigating Cancer management solution system to help the network cut down the time it takes to resolve patient phone calls while also collecting feedback. Launching the system required lots of homework: Texas Oncology physicians examined the patterns of how patients called in community practices, whether they went through a phone tree or spoke with a nurse, and what kind of training that person had received. They examined call volume levels at different sites across the network. The result, Wilfong said, is a new system with the following steps:

• Patients report symptoms to a centralized system operator
• The operator manually adds the patient’s report to the triage workboard
• A triage nurse provides symptom management and resolves remotely, with instructions sent directly to the patient.

Wilfong said the new system has cut down incident resolution time by 33%.

The Navigating Cancer pathways are a key step in the process, he said. The operator who takes patient calls uses them to log information into the dashboard, and, ultimately, to send care instructions home to the patient.

“Which is great, because how many times does a patient call in with diarrhea?” Wilfong said. “And the nurse talks them through it and says, ‘Why don’t you use Imodium?’” Often, patients forget what the nurse says about what to do if things do not improve. But in the new system, home care instructions are automatically sent to the patient—and the caregiver.

Wilfong said the improved resolution time has happened despite a 35% uptick in call volume in the second half of 2020, most of which is due to COVID-19. “Our nurses are becoming faster at taking care of patients,” he said. “What’s really impressive is that 60% of these incidents are resolved in less than an hour, which is fantastic. We’re having better, more proactive, timely symptom management with this process.”

When nurses must make a judgment call, they are asked: did this intervention prevent the person from going to the emergency room or the hospital. “What we’ve seen 8% of the time, our nurses are saying, ‘What we did prevented this person from going to the hospital or the emergency department.’ And 8% is not a huge number, but if you think of 8% of a million, that’s a lot of prevented hospitalizations.”

The next step, Wilfong said, was to move to ePROs and remote patient monitoring. “What's exciting about this, is that instead of the patient having to pick up a phone and call in a problem to the operator, they can remotely digitally report into us,” he said. “Those incidences get electronically transcribed, and then go directly to the nurse or resolution.”

“We just started this process a few months ago, we've already seen 16% of our symptom incidence are submitted via this digital monitoring tool versus patients having to call in,” Wilfong said. The network is engaged in an implementation effectiveness study of real-world digital monitoring called “Texas Two-Step.”

From July to December 2020, Texas Oncology enrolled 4,375 patients, including 25% who live more than 20 miles away from the clinic. Participation rates are excellent—73% of patients who are taking therapy are enrolled, and 65% continue to have ePRO assessments.

“So, that’s a very strong compliance rate with this tool,” he said.

The goal, Wilfong said, is to build on the Triple Aim by improving patient experience, care quality, and satisfaction. “By proactively managing their symptoms, we want to improve the health of the population by keeping them out of the hospital and ED, allow their quality of life to be better, and ultimately reduce the cost of care.”