Dr Mark Soberman Discusses Integrated Care Teams in Oncology

Integrated care teams will create more value for the patient, but there are multiple challenges in the creation of these teams, said Mark Soberman, MD, MBA, FACS, former president of the Association of Community Cancer Centers.

What challenges are care teams facing in cancer as they try to create integrated care teams?
The challenges are multiple. We know that the ideal is integrated care teams that are centered around the patient and their condition, and that provided coordinated, comprehensive care for the patient. We have multiple different care models and practice models around the country.

We have, on one hand, places like MD Anderson Cancer Center in Houston, where they have departments that are based upon the patient’s diagnosis—so, there’s a department of head and neck cancer, which includes medical oncologists, radiation oncologists, radiation oncologists, surgical oncologists, navigator all in 1 place, co-located, sharing space. Seeing the patient together as a team.

Then you have on the other extreme, a smaller community where you may have an independent medical oncology practice, an independent radiation oncology practice, perhaps independent surgeons, and how do you bring all of them together centered around the patient. So, part of the challenge is that. Then, in addition, you need a nexus to bring the caregivers together. So, there’s that.

And then, the last challenge is that current reimbursement models often don’t incentivize that care because there are resources that need to be brought to bear: navigators, social workers, facilities. And, so, there are not great incentives from a payment standpoint in order to do that. That having been said, a lot of providers are stepping up and doing it because it’s the right thing. You have groups of community providers who are banding together and creating integrated care programs for their patients either partnering with a health system or doing it on their own. So, we are seeing more and more of this, but there’s no doubt that there are continued challenges on a multitude of fronts.

How does the move toward value-based care require more integrated care teams?
The way you create value for patients is to center the care around the patient and their medical condition and not the providers. That’s the first thing, because, ultimately, patients come to us with the diagnosis of breast cancer, lung cancer, colorectal cancer, prostate cancer, not surgical oncology, radiation oncology, or medical oncology. In order to really create value, we have to center the care around the patient, so that’s the first piece.

The second is that there is no doubt that the payment models are going to evolve, I think, more toward episodic-based payment for care—meaning, probably bundles or some version of bundles. And, lastly, I think that as care teams, we’re going to be accountable one way or the other for the outcome of that care and the value of that care, which means that we have to work together to maximize the outcome for that patient, control the cost of care, and, overall, create value for the patient.
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