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Filling the Donut Hole in Oncology Care With Collaboration and Navigation

Surabhi Dangi-Garimella, PhD
To discuss the progress in care collaboration and also what is currently lacking in care practices in oncology, The American Journal of Managed CareĀ® invited Rebekkah Schear, MIA, LIVESTRONG Foundation, and Michael Kolodziej, MD, Flatiron Health.
Healthcare, of late, has seen a lot of movement toward improved care delivery and reimbursement, with several experimental models being tested in the field by CMS and private health plans. The emphasis is on collaboration and communication: data sharing and team-based care can offer providers a multidimensional view of the patient and improve outcomes.

To discuss this progress and what is currently lacking in care practices in oncology, The American Journal of Managed Care® invited Rebekkah Schear, MIA, director of mission delivery at the LIVESTRONG Foundation, and Michael Kolodziej, MD, former national medical director of oncology strategies at Aetna and currently the national medical director of Managed Care Strategy at Flatiron Health. The telepanel was moderated by Joseph Alvarnas, MD, editor-in-chief of Evidence-Based-OncologyTM. Alvarnas is associate clinical professor and director of medical quality, risk, and regulatory management, City of Hope, Duarte, California.

The panel began with Alvarnas asking each participant to define what patient-centeredness and shared decision making mean in oncology care. According to Schear, patient-centeredness is the new paradigm for care delivery, as reflected by major shifts in policy and practice. Considering how complex cancer care is, with the uncertainty and life-changing decisions, patient-centeredness is all the more important. “Reports have come out in 2013 that list 6 core elements of what delivery of cancer care should look like moving forward and how patient-centeredness, shared decision making, coordination of care, a learning healthcare system, all of these things, are sort of embedded in what that might look like,” she said. Although this is being implemented, she believes there’s room for improvement.

What about the potential for information overload? How can patients and their caregivers be effectively engaged in care planning without inundating them with details? Kolodziej explained that oncologists believe they are doing a perfectly fine job in educating patients and including them in treatment decisions. Payers, on the other hand, do not have much insight into how well this is being implemented by oncologists, but he agreed with Schear that there are shortcomings to the process. “The biggest shortcoming really boils down to the fact that when a newly-diagnosed patient comes into your office with, or without, supportive family members or friends, there is just such a knowledge gradient and it’s such a loaded conversation. It’s very hard to process it,” Kolodziej said.

Despite a few unsuccessful attempts, Kolodziej thinks we are currently at a point where there is some bit of standardization of communication systems for use between the members of the team of providers who are caring for the patient. In his opinion, the Oncology Care Model (OCM), which requires a documented care plan based on the Institute of Medicine’s 13-point Care Management Plan, exemplifies this.1 The “major component there is the first dialogue with the patient regarding the treatment plan and expectations from treatment.”

The OCM wants providers to give patients access to all the information that they might need to understand their care plan, once the patients have adjusted to the shock of being diagnosed with cancer. “Because it’s something that we think the patient will need to come back to frequently in order to totally get the entire picture of the complexity and the enormity of the care they’re going to receive,” Kolodziej said.

Cancer Care Plan: Documentation and Communication
Alvarnas asked Kolodziej to provide insight on the importance of documenting the treatment plan for cancer patients, an objective of the Planning Actively for Cancer Treatment or PACT Act.2 Kolodziej emphasized that documentation and processes of care, especially for emergency department visits and inpatient stay, are very important for both the patient and caregiver to understand how care will be managed. Another dimension to this pertains to healthcare reform and integrated care, where poor communication among physicians has been well documented. “A standard means of communication among multiple care management teams is important, especially for Medicare patients,” Kolodziej added.

Documenting the treatment plan creates functionality for patients, particularly post treatment, Schear said. Doing so can help patients and their families find a path of continuity as they adjust to the “new normal” of survivorship. Its important, she added, that all providers, particularly the primary care providers (PCPs), be aware and integrate the patient’s current treatment with reference to what they have gone through for their cancer care. “That’s not just physically, but emotionally. The psychosocial perspective is critical,” said Schear.

To listen to this panel discussion, please click here: 

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