Dr Susan Escudier Talks Barriers in Oncology Specialist, PCP Collaboration


The biggest barriers in collaboration are communication and connectivity, said Susan Escudier, MD, FACP, vice president of value-based and quality programs for Texas Oncology.

Susan Escudier, MD, FACP, vice president of value-based and quality programs for Texas Oncology, explains how oncology specialists and primary care physicians can collaborate under a value-based care model, and what barriers there may be.


What are some barriers in collaboration between oncology specialists and primary care physicians in value-based care, and how can this be improved?

To me, the biggest barriers are communication and connectivity. I think, generally speaking, if we can speak to a doctor one to one—sort of private practice one on one—we can make sure that we are all on the same page, we're all rowing in the same direction. I think that the problem sometimes are they may have trouble getting through to us, we may have trouble getting through to them. It's really nice if you have a seamless electronic medical record where you can communicate with each other. Most of us aren't going to have that with every referring group we work with, but that, to me, is the biggest obstacle.

For example, I can't tell you how many insurance plans I'm on. And even within every plan like Blue Cross Blue Shield, there's probably 10 subplans. So, it's really important that we have people in our offices who understand how to navigate the requirements of the insurance companies so that we can all, again, make sure that we are fulfilling their expectations for us. And many of these plans, for example, have performance-based payments, and so we have to pay attention to what it is that they're asking for us to show on that for that performance.

How can they work together to overcome barriers in early cancer screening and prevention, especially in underserved communities?

I think on the primary care standpoint, they're really carrying most of the weight there. And I think many of them probably have reminders in their systems of when patients are due for these things. I think that if you ask patients why they do things, the number one reason is "because my doctor told me to." So, just reaching out to patients, just talking to them. I make a point whenever I see a patient, for example, for breast cancer follow up to say, "When was your last colonoscopy? When was your well woman exam?" So, I think we have to be very mindful and straightforward with our patients that this is what they should be doing.

I think for communities that are underserved or aren't partaking of the screening, we may have to use different approaches, because we know that the type of approach we use, for example, to get screening mammograms works great for about 67% of our patients. Same thing for colon cancer screening. So, we have to think a little bit outside the box in terms of, how do we reach out to the communities that either aren't hearing the message or aren't listening to it?

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