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Investing in the Vital Role of a Cancer Care Coordinator

Surabhi Dangi-Garimella, PhD
At the Association of Community Cancer Centers' 44th Annual Meeting & Cancer Center Business Summit, held March 14-16, 2018, in Washington, DC, panelists shared strategies that have helped their organizations adapt to value-based care while ensuring that they never lose sight of the patient at the center of it all.
Neubauer provided an overview of the Oncology Care Model (OCM), which funds practice transformation and demands:
  • Patient navigation programs
  • 24/7 access to care
  • Implementation of the Institute of Medicine care plan
  • Advance care planning (ACP)
  • Team-based care
  • Quality measurement reporting
  • Using data to allow continuous learning.
During a webinar hosted by The American Journal of Managed Care®, Kashyap Patel, MD, of Carolina Blood & Cancer Care, emphasized that OCM participation for his practice was not as big a challenge because they had been adopting some of those care practices over the years.

At the ACCC meeting, Neubauer explained that the Centers for Medicare & Medicaid Innovation, which has developed the OCM pilot reimbursement program, delivers data files to participating practices on a quarterly basis. “The raw data need to be converted to actionable information for practices," Neubauer said.

This information, of course, is vital for process improvement. Neubauer showed analyses of these data conducted by his organization that helped identify patients at high risk of hospitalization following chemotherapy, based on gender and age.

“Also, the data can provide a glimpse of risk of hospitalization following chemotherapy, based on disease type. It also gives us the ability to follow patients at higher risk if they have comorbidities,” he said. As the bottom line, it can significantly impact proactive case management to reduce these hospitalizations in these specific patient populations.

Evaluation of the impact of ACP on end-of-life choices by patients at their practices showed that 88% of those with ACP died at home or in hospice. In the non-ACP population, 77% died at home or in hospice care.

These data, when fed back into the system, can help practices implement positive changes and create a learning system.

Another growing concern within oncology is caring for survivors and coping with posttreatment health issues. Tofani discussed this as a last part of the puzzle of care coordination and directed the audience’s attention to the use of clinical practice guidelines to coordinate survivorship care.

“In less than 8 years, there will be 20 million cancer survivors in the United States. Why is survivorship care important?” Tofani asked. She noted that cancer survivors are faced with numerous issues, such as recurrence, secondary cancers, psychosocial effects of their disease and treatment, comorbidities due to other chronic diseases, and more.

Hunterdon, Tofani said, developed a survivorship program for better coordination of survivor care that was modeled on the National Coalition for Cancer Survivorship and the George Washington University Cancer Center toolkit and guidelines.

She said that studies have shown that primary care physicians (PCPs) and oncologists are confused about survivorship care and follow-up care, “which affects both the quality and cost of care.” Tofani said that Hunterdon has promoted their clinical practice guidelines and care coordination among specialists and PCPs as one of the first steps to improve survivorship care in their patient population.

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