How would healthcare reform impact cancer care delivery and reimbursement? Will value-based models push for a more integrated and ideal care delivery for oncology patients?

Rebekkah Schear, MIA, thinks that the Oncology Care Model (OCM) is a good start and its impact will become clear over time. However, she does expect to see a positive impact on navigation care planning, with the patient at the center of the process. “We are moving from “an illness-centered perspective toward a person-centered perspective,” Schear said.

Michael Kolodziej, MD, said that he too, is looking forward to learning what implementation of the OCM will do, as data would be scrutinized for quality and process improvement while keeping the patient front and center. “The idea that you do things because this is the way we do things, and the patient’s kind of peripheral to all this, that’s disappearing,” he added.

"I think what we're seeing, and I hope will continue to be seen, is that patient centeredness is the point," Schear said, adding that "all opportunities moving forward to help patients and families sort of articulate our humanity and fore care systems evolve towards supporting patients in their individuality and to really look at holistic healing—healing's in the perspective of this multidimensional place and looking at people."

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Can care delivery and payment reform in healthcare help tide us over the existing gaps in cancer care?

Segment 9 - Impact of Healthcare Reform on Cancer Care

Joseph Alvarnas, MD, asked the panels opinion on what they perceive as opportunities for improving survivorship care. "What do you see as the gaps in survivorship care?  You mentioned some of them earlier. What are they and how do we get towards this idea of really preparing patients for their life after cancer?" he asked.

In response, Rebekkah Schear, MIA, shared results of a LIVE

survey from several years ago that found that a majority of patients had at least 1 posttreatment physical, emotional, or practical concern. However, 29% said they did not receive care for their physical concerns, nearly 50% voiced lack of follow-up care for their emotional concerns, and one-third did not get follow-up care for practical concerns. Less than half of the patients reported having conversations on fertility preservation and fertility risk with their provider. "I think that across the board we're seeing the needle begin to move a little bit in terms of survivorship evolving as a movement," Schear said.

Lending his experience as an oncologist to the discussion, Michael Kolodziej, MD, said that a lot remains unknown with chemotherapy agents. He cited examples of patients with breast cancer whom he had treated about 2 decades ago and who were concerned about cardiac effects post treatment with Adriamycin or Herceptin—drugs known to be cardiotoxic. He said he was at a loss for information because not much was known back then about survivorship care. In his opinion, primary care providers need to play a much bigger role in caring for patients who have survived a cancer diagnosis and treatment.

"If we can start to develop the evidence base that will allow us to give good recommendations to our patients and to our primary care physician colleagues, we'll actually improve the life and promote the wellness of our patients for a long, long time," Kolodziej said.

How can care providers ensure cancer survivors continue to receive adequate follow-up care post treatment?

Segment 8 - Covering the Gaps in Cancer Survivor Care

"The issue of advanced care planning, end of life, and hospice which were earlier raised I think are also a challenge for many oncologists," said Joseph Alvarnas, MD. He cited a study published in 

revealed that there is discordant understanding on the prognosis between the physician and the patient. The patients seemed to be more optimistic about their survival prognosis, while the oncologists may not.  Alvarnas wanted to know how this could be rectified.

Rebekkah Schear, MIA, narrated the story of a friend who lost her father to cancer and then her mother was re-diagnosed. The family could not agree on the treatment plan, especially when deciding on the mother’s transition from active treatment to hospice. "I think that's it a very emotional, challenging subject and the experience of family members and the dynamics of families plays into that in a significant way." She added that a nurse navigator or a social worker can play an extremely important role in guiding the family through the process.

Going back to her friend's story, Schear said, "I got on the phone with a 3-season nurse navigator who had been working in oncology for over 25 years, and with her sisters we sort of helped them the set of questions that they should be asking the rest of the family and also questions to pose to their mom about what she wanted as her cancer journey came to a place where it was and as her prognosis worsened."

Michael Kolodziej, MD, said that as he looks at this now as an outsider who’s been there, he realizes how certain aspects of care are managed very poorly or not handled at the right time. “We do it when we’re facing a crisis typically. That’s not when you get the most responsive, receptive, constructive dialogue necessarily going.” The entire treatment plan should be addressed right up front, and the opinions of the family members should also be given consideration. 

When asked if CMS coverage for discussions on advance care planning for Medicare patients would push this process, Kolodziej said he didn't think so.

How can discussions on advance care planning and end-of-life care be successfully broached with patients and their family members?

Segment 7 - Successful Discussions on Advance Care Planning and EOL

When asked how payment models can be developed that ensure care delivery is patient-centered, Michael Kolodziej, MD, said he is not worried about the reimbursement, rather he is "worried more about the operations. I'm worried a little bit about culture change within the practice."

 He explained, "As we go towards a value-based reimbursement methodology, it's absolutely crystal clear to me that if we can execute on behavioral health, for example, or execute on advanced care planning and end-of-life care, palliative care, it's going to actually generate savings for the healthcare system at large. It's going to improve patient satisfaction.  It'll improve patient outcome and there'll be a wonderful win."

Kolodziej believes its more important to develop better care strategies for patients. "I think ultimately doctors will find it's a great way to change how care is delivered," he added.

Rebekkah Schear, MIA, agreed, highlighting the importance of patient and family education, particularly for important process like palliative care. "Palliation in and of itself, I think, is misunderstood and highly stigmatized, especially in cancer care," she said. "But we know that when patients and families have a thorough and more robust understanding of how pain management and palliation can actually improve quality of life, regardless of whether someone might be living with disease for a good chunk of the remainder of their cancer journey or whether they have advanced-stage cancer and they're treating pain and working to improve quality of life all throughout," Schear added.  

The discussion then moved on to the importance that of a care navigator to the process. Kolodziej said, however, that there is not standard definition of a navigator. "I actually like thinking about  a navigator, or more precisely navigator function, in the context of team-based care," he added.

Panelists discussed how patient-centered care can be valuated in the changing healthcare climate.

Segment 6 - Reimbursing Value-Based Oncology Care

"What does a good patient portal look like so that these technologies and this care coordination can be accessible to a broad set of constituencies?" Joseph Alvarnas, MD, asked the panelists. "Does anybody do this well?"

According to Rebekka Schear, MIA, while a lot of the existing platforms are technically sound, what they are missing are a more holistic approach to patient care. "If you look at a lot of what Epic offers, you've got the ability to in many cases send an e-mail to your provider. You've got a patient profile. Your information is constantly updated. You can go in and access and update it. Your medication history is on there. You can send a confidential or private message and things like that," she said.

"But I think what we're missing is that holistic patient perspective. What I think from my perspective what we've literally done is just taken the very 2-dimensional nature of a patient and then sort of projected it into this digital dimension," she added. Schear would like to see health information platforms reflect the values of the patient.

Michael Kolodziej, MD, added that the patient portals "were note really built to be useful to the patient. That wasn't the intention. The intention was to meet meaningful use criteria. I think that perspective is in the process of change." 

Is there anything like an ideal patient portal that can cater to a broad range of patients? According to Rebekkah Schear, MIA, what patient portals lack is a holistic approach toward the patient. 

Segment 5 - An Ideal Patient Portal

Joseph Alvarnas, MD, asked the panelists' thoughts on a proposed timeline for when patients and the healthcare system could anticipate a technological fix to the existing problem of interoperability.

Rebekkah Schear, MIA, said that several patient-friendly apps have been developed that ensure patients have access to their health information and a line of communication with their care provider. Schear also highlighted the importance of wearable devices for a more real-time sharing of patient information with their care provider(s). 

"I think the general point is there has to be a balance between having immediate access to most things in our lives from a communications perspective and knowing that the health sector is going to be a little bit slower to catch up," Schear said. "But at the same time, we need to overcome this thick barrier between providers and patients where provides aren't necessarily able and available to connect with patients with immediacy. There needs to be some sort of balance there," she added.

Both Schear and Michael Kolodziej, MD, agreed that the evolution of HIPAA is inevitable and it has to keep pace with the technological advances within healthcare.

How can we create more standardized health information platforms that can easily exchange patient information?

Panel Discussion

Segment 9 - Impact of Healthcare Reform on Cancer Care

Segment 8 - Covering the Gaps in Cancer Survivor Care

Segment 7 - Successful Discussions on Advance Care Planning and EOL

Segment 6 - Reimbursing Value-Based Oncology Care

Segment 5 - An Ideal Patient Portal

Segment 4 - Overcoming Barriers With Data Exchange